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The 

Drug  Habits  and 

Their  Treatment 


A  Clinieal  Summary  of  Some  of  the  General 
Facts  Recorded  in  Practice. 


By  T.   D.   CROTHERS,  M.  D., 

SUPERINTENDENT  WALNUT   LODGE   HOSPITAL,  HARTFORD, 

CONN. ;    PROFESSOR  DISEASES   OF  THE  BRAIN    AND 

NEKVOUS  SYSTEM,      NEW    YORK   SCHOOL 

OF  CLINICAL  MEDICINE,N.Y.    ETC. 


CHICAGO: 

G.  P.   ENGELHARD  &  COMPANY, 
1902. 


Copyright  1902 
By  G.  P.  ENGELHARD  &  COMPANY. 


>- 

-J 

o 


PREFACE. 

The  Disease  of  Inebriety  is  now  passing  through 
the  empiric  and  squatter  stage  of  development, 
which  meets  every  new  truth  of  science.  The 
partial  recognition  of  the  Disease  of  Inebriety  has 
attracted  the  empirics,  who,  like  squatters  in  a 
new  country,  rush  in  and  occupy  the  land  with 
great  noise  and  pretension.  They  never  build 
towns  or  cities,  or  develop  the  country,  but  dis- 
appear when  permanent  settlers  arrive.  This  lit- 
tle work  comes  in  the  capacity  of  a  permanent 
settler,  and  aims  to  point  out  some  of  the  general 
facts  and  conditions  of  Inebriety,  and  to  indicate 
the  great  possibilities  awaiting  further  research 
and  more  exact  study.  The  curability  of  this  form 
of  neurosis  is  established  beyond  question,  from 
the  limted  studies  and  experience  of  the  present. 
Evidently  we  are  on  the  threshold  of  a  new  realm 
of  practical  science,  in  the  study  and  cure  of  the 
Disease  of  Inebriety,  and  the  results  may  exceed 
any  present  expectation. 

The  Journal  of  Inebriety,  which  was  established 
in  1876  to  promote  the  study  of  spirit  and  drug 
neuroses,  has  published  nearly  all  the  literature  on 
the  subject  for  the  past  quarter  of  a  century.    The 


6  DRUG  HABITS  AND   THEIR   TREATMENT. 

student  of  tliis  topic  lias  to  do  pioneer  work  with 
little  or  no  aid  from  others,  and  this  Yolume  comes 
as  an  assistant  to  suggest  lines  of  study  and  point 
out  the  direction  for  future  inquiries. 

These  neuroses  are  rapidly  increasing,  and  their 
study  and  treatment  is  hecoming  more  and  more 
imperative.  The  colleges  will  have  to  add  to  their 
curriculum  this  new  tield  of  study;  alread}^  a  ISTew 
York  college  has  taken  up  this  subject  and  lectures 
are  given  on  the  topic.  This  work  is  only  a  gen- 
eral discussion  of  a  topic  which  will  be  treated 
by  the  author  more  exhaustivel}^  in  a  larger  work 
now  preparing.  If  this  work  brings  new  interest 
to  the  subject  and  increases  the  number  of  scien- 
tic  workers,  its  object  will  be  accomplished. 

T.  D.  CEOTHERS,  M.  D. 


CONTENTS. 


CHAPTER  I.  PAOE 

Habit  and  the  Damages  of  Alcohol        ...  9 

CHAPTER  II. 
Dipsomania ,     .     .     .       29 

CHAPTER  III. 
^  Opium  Inebriety        61 

CHAPTER  IV. 
Cocain  and  other  Drug  Habits 75 


CHAPTER  I. 

HABIT,  AND  THE  DAMAGES  OF 
ALCOHOL. 

The  popular  and  common  meaning  of  the  word 
habit  is  some  state  or  condition  of  the  body,  vol- 
untarily acquired  and  continued  at  the  will  of  the 
person.  Conduct  and  acts  which  can  be  changed 
or  checked  by  the  will,  and  are  apparently  under 
the  control  of  the  person,  are  called  habits.  In 
its  broader,  scientific  sense,  there  is  a  physiological 
and  psychological  tendency  to  repeat  the  same  acts 
apparently  outside  of  the  control  of  the  will.  It 
is  this  meaning  of  the  word  habit  which  will  be 
used  in  the  present  study. 

Of  all  the  drugs  used  either  medicinally  or  as 
beverages,  alcohol  seems  to  be  the  most  destructive. 
In  recent  times  this  fact  is  becoming  more  and 
more  apparent  in  science  studies.  All  the  recent 
text-books  on  the  practice  of  medicine  recognize 
the  dangers  from  the  use  of  alcohol,  and  its  influ- 
ence as  a  contributory  cause  in  many  of  the  organic 
diseases  of  the  body  and  brain.  The  modern 
clinician  inquires  into  the  history  of  the  use  of 
alcohol,  either  moderately  or  immoderately,  and 
this  fact  is  important  in  a  knowledge  and  treat- 
ment of  the  cause.  Next  to  syphilis,  alcohol  is  one 
of  the  most  potent  poisons  in  the  causation  of  dis- 


10  DRUG   HABITS  AND  THEIR  TREATMENT. 

ease.  In  the  neuroses,  alcohol  is  very  prominent 
as  an  active  or  contributory  cause.  The  various 
palsies,  mental  derangements,  and  disturbances  of 
nutrition,  circulation  and  obscure  organic  af- 
fections, are  always  better  understood  when  all 
alcoholic  causation  is  eliminated.  In  pneumonia, 
the  prognosis  is  very  different  where  there  is  no 
history  of  the  use  of  alcohol.  In  surgical  treat- 
ment the  fact  of  the  use  of  alcohol  complicates 
the  results.  While  alcohol  is  still  used  as  a  medi- 
cine in  many  instances,  its  influence  as  a  cause  of 
disease,  both  active,  predisposing  and  contributory, 
is  becoming  more  and  more  prominent.  Eecent 
researches  show  that  alcohol  has  a  peculiar,  cor- 
roding action  on  the  cell  and  tissue.  It  is  not  only 
a  toxin  but  produces  toxins  which  are  chemical  and 
physical  poisons.  Every  new  advance  in  the  chemic, 
physiologic,  pathologic  and  psychologic  fields 
brings  out  this  fact  of  the  danger  of  alcohol  either 
in  moderation  or  in  excess.  The  increasing  num- 
ber of  cases  which  become  disabled  and  degener- 
ate in  almost  every  community  from  the  use  of 
alcohol  suggests  something  more  than  moral  lapses 
and  sinful  weakness. 

HISTORY  AND  ASSOCIATIO^ST  WITH  OTHER  DISEASE. 

A  clinical  study  of  accurately  grouped  histories 
of  a  large  number  of  cases  brings  ample  confirma- 
tion of  the  fact  that  inebriety  or  alcoholism  is  a 
disease.    A  closer  study  of  these  causes  indicates  a 


HABIT,  AND   THE  DAMAGES   OF   ALCOHOL, 


11 


distinct  and  clearly  traceable  causation,  also  a 
uniform  development  and  progress,  and  a  uniform 
symptomatology  and  termination.  The  physical 
conditions  apparently  resulting  from  the  poison- 
ings of  alcohol  on  the  nerve  centers  and  organic 
activities  appear  to  follow  a  definite,  organized 
line  of  degeneration  whose  progress  and  termina- 
tion can  be  traced  with  much  certainty. 

The  idea  of  disease  is  very  old,  and  dates  back 
to  the  early  ages  of  the  world.  The  fathers  of 
medicine  asserted  that  drunkenness  was  a  disease, 
and  curable  as  other  diseases.  Hippocrates,  Galen, 
and  many  of  the  old  worthies  gave  strong  opin- 
ions on  this  subject  but  these  facts  were  not  formu- 
lated into  theories  until  the  beginning  of  this  cen- 
tury when  Dr.  Eush  in  this  country,  and  Salvator 
of  Russia,  and  Cabanis  of  France,  formulated 
and  put  into  active  service  these  facts.  The  disease 
of  inebriety  and  its  pathology  and  treatment  has 
been  studied  more  accurately  in  America  than  else- 
where. The  first  inebriate  asylum  organized  in 
1864,  took  up  this  subject  as  a  medical  one  in 
advance  of  all  others.  From  that  time  the  growth 
of  the  subject  has  extended  all  over  the  world, 
and  researches  and  literature  have  been  very 
largely  the  result  of  the  efforts  of  Americans.  The 
Journal  of  Inebriety,  the  organ  of  this  new  study, 
has  been  published  since  1876,  giving  researches 
and  facts  along  this  line  exclusively. 


12  DRUG   HABITS  AND   THEIR   TREATMENT. 

When  the  drink  symptoms  of  alcohol  are  ex- 
amined with  more  care,  they  are  found  to  be 
closely  related  to  a  great  variety  of  neurotic  dis- 
eases. In  many  cases  they  appear  to  be  phases  or 
types  of  epilepsy,  hysteria,  neuralgia,  also  closely 
allied  to  consumption,  and  intimately  connected 
with  heart  disease.  Many  of  the  degenerations 
of  the  nerve  centers,  such  as  the  palsies,  the  paretic 
states,  have  alcoholic  stages  and  symptoms.  ISTeu- 
rasthenia  in  all  its  types  and  forms  is  often  man- 
ifest in  this  way.  jSTerve  storms,  such  as  head- 
ache, neuralgias  of  the  stomach,  and  various  parts 
of  the  body  often  precede  and  follow  alcoholic  ex- 
cess. The  vaj-ious  organic  and  functional  affec- 
tions of  the  heart  often  exhibit  tliis  drinlc  symp- 
tom. Tuberculosis  alternates  with  drinlc  excesses. 
At  one  time  acute  symptoms  of  breaking  down  of 
nerve  structure  is  checked  by  the  advent  of  a  drink 
craze.  When  this  subsides,  the  acute  symptoms 
reappear.  Not  unfrequently  they  are  associated, 
and  it  is  difficult  to  decide  which  is  cause  and 
which  is  effect.  The  epilepsies  seem  to  have  drink 
symptoms  more  commonly  than  other  diseases,  the 
drink  craze  taking  the  form  of  paroxysm  and  sub- 
siding after  a  time  in  ranch  the  same  way  as  the 
epilepsies.  The  periodical  drinkers  are  very  largely 
of  the  class  of  explosive  epilepsies  in  which  nerve 
energy  gathers  and  bursts  at  stated  intervals.  The 
frequent  use  of  alcohol  in  these  neurotic  cases 


HABIT,  AND   THE   DAMAGES   OF   ALCOHOL.  13 

suggests  the  disease  character  and  the  action  of  phy- 
siological laws  which  are  at  present  largely  unknown. 

FORMS      OF     INEBRIETY      AND     DRINK     HABITS. 

The  various  forms  of  alcoholic  drinking  may 
be  grouped  into  three  classes,  namely,  the  contin- 
uous, the  periodical,  and  the  regular.  Beyond  this 
there  is  a  class  which  may  be  called  the  contagious 
or  neurotic  cases  which  seem  not  to  drink  except 
from  peculiarly  exciting  conditions.  These  various 
classes  are  well-known  and  often  merge  into  each 
other. 

The  continuous  drinker  seems  to  possess  the 
poAver  of  using  alcohol  in  uniform  doses  at  short 
intervals  without  exhibiting  any  marked  derange- 
ments of  character  and  conduct.  He  belongs  to 
those  who  pride  themselves  on  being  able  to  drink 
without  any  serious  damage.  They  are  the  mod- 
erate drinkers  in  every  community  whose  masked 
condition  is  misleading  to  all  except  to  physicians. 
They  die  suddenly  from  congestion  of  the  brain, 
hemorrhage  or  pneumonia.  Often  they  are  found 
dead  in  bed  or  die  from  heat  or  sun-stroke.  Some 
of  these  persons  become  insane,  usually  of  the 
type  of  dementia.  Others  have  palsies  from  which 
they  never  recover.  Such  persons  suffer  first  in 
the  community  from  the  presence  of  epidemic 
diseases,  and  seem  to  have  no  resisting  power  to 
concussions,  injuries  or  shocks.  The  spirit  and 
beer-drinking  longshoremen  at  Liverpool  have  a 


14  DRUG   HABITS   AND   THEIR   TREATMENT. 

frightful  mortality.  Yet  they  are  types  of  physical 
strength  and  vigor  and  seldom  appear  to  suffer 
from  intoxication.  They  are  unable  to  resist  the 
slightest  attack  of  disease,  and  die  from  the  sim- 
plest injuries.  In  this  country  few  moderate  drink- 
ers attain  the  average  longevity  of  the  race  unless 
they  are  muscle  workers  and  live  in  the  open  air. 
As  brain  workers,  living  indoors,  their  length  of 
life  is  greatly  diminished. 

Most  of  the  drinkers  after  a  variable  time  merge 
into  periodical  or  impulsive  drunkards,  and  drink 
to  stupor  or  maniacal  conditions.  It  rarely  hap- 
pens that  men  can  drink  in  moderation  in  this 
country  where  the  condition  of  mental  strain  is  in- 
tense and  exhaustive.  The  periodical  drinker  is 
always  a  neurotic.  The  excessive  use  of  spirits 
after  a  free  interval  is  of  the  nature  of  a  nerve 
storm.  The  morbid  gathering  of  the  energies  of 
the  system  explodes  in  this  impulsive,  unreasoning 
demand  for  relief  which  alcohol  most  quickly 
overcomes.  There  will  be  perfect  freedom  from 
desire,  and  even  distrust  for  spirits  up  to  a  cer- 
tain point ;  then  an  overpowering  impulse  to  drink 
will  follow.  Nothing  short  of  complete  satura- 
tion from  alcohol  and  profound  and  repeated  nar- 
cotism, which  seems  to  exhaust  the  nerve  energies, 
will  satisfy  this  morbid  demand.  The  abrupt  be- 
ginning and  sudden  termination  of  the  drink 
paroxysm  indicates  its  neurotic  nature. 


HABIT,  AND   THE  DAMAGES   OR  ALCOHOL.  15 

Then  follows  a  long  free  interval.  In  some 
instances  the  return  of  the  drink  paroxysm  is  uni- 
form as  to  time,  rarely  varying  more  than  an  hour. 
This  periodicity  is  so  absolute  and  positive  that 
it  can  be  traced,  and  even  anticipated.  In  other 
cases  it  is  irregular,  and  depends  upon  unknown 
conditions  or  on  some  special  exciting  cause,  which 
when  removed,  is  followed  by  a  cessation  of  the 
paroxysms.  Many  of  these  eases  are  literally  epi- 
leptoid,  and  frequently  merge  into  convulsive 
spasms  which  are  called  alcoholic  epilepsy.  The 
palsies  after  the  cessation  of  the  drink  craze  and 
the  convulsive  activity  of  the  muscles  indicate 
central  brain  lesions  of  grave  character.  The 
symptomatology  of  these  cases  is  a  very  inter- 
esting study,  and  while  each  case  differs  widely 
there  is  often  a  uniform  movement  which  can  be 
readily  traced. 

SYMPTOMATOLOGY  AND  CLASSES  OF  DRINKING  MEN. 

Many  of  these  cases  appear  among  the  active 
brain  workers  of  the  country,  and  their  addiction 
is  concealed.  The  sudden  disappearance  of  ener- 
getic, active  men,  and  their  return  in  a  week  or 
two  a  little  paler  are  the  general  indications  of 
these  alcoholic  attacks.  Some  of  these  cases  use 
spirits  only  at  midnight  and  alone.  Others  never 
drink  except  at  the  club  and  in  certain  company; 
and  then  only  at  stated  intervals.    Many  of  these 


16  DRUG   HABITS   AND   THEIR  TREATMENT. 

persons  frankly  confess  that  they  go  off  to  indulge 
in  this  alcoholic  narcotism,  that  it  is  an  irresist- 
ible charm  which  they  are  powerless  to  control. 
Others  conceal  these  attacks  or  explain  them  aa 
due  to  other  causes. 

Not  unfrequently  these  attacks  end  in  acute 
mania  from  which  recovery  is  very  slow,  and  in 
many  cases  does  not  follow.  After  the  subsidence 
of  the  drink  storm,  the  mind  often  retains  its 
exalted  and  delusional  state,  and  permanent  men- 
tal troubles  begin.  Some  of  the  most  dangerous 
homicidal  cases  have  followed  the  drink  excess  of 
periodical  drinkers.  General  paralysis  is  often 
a  sequel  of  this  form  of  drinking.  Paranoia,  and 
many  of  the  obscure  mental  disorders  come  from^ 
this  cause. 

The  third  class  of  irregular  or  impulsive  drink- 
ers are  very  numerous,  and  drinlc  or  abstain  from 
causes  and  conditions  very  obscure.  Sometimes  a 
period  of  abstinence  extending  over  years  will 
occur,  then  they  will  drink  to  excess  and  continue 
at  irregular  intervals  for  an  indefinite  time.  Such 
persons  drink  when  excited  or  from  overwork  or 
underwork  or  any  other  causes  which  seem  to 
break  up  the  uniformity  of  their  life  and  surround- 
ings. Many  of  these  persons  explain  the  drink 
craze  by  the  most  trifling,  childish  theories.  Often 
they  appear  in  temperance  meetings,  and  describe 
with  great  minuteness  their  sin  of  drinking,  giving 


HABIT,  AND   THE  DAMAGES   OF   ALCOHOL.  17 

great  prominence  to  the  struggles  which,  they  claim 
to  have  undergone  in  the  effort  to  abstain  trom 
drink.  They  are  also  prominent  at  prayer-meet- 
ings, and  pose  as  types  of  the  power  of  conversion. 
There  is  in  this  class  a  mixture  of  imbecility  and 
delusional  cunning  which  is  not  well  understood. 
At  times  they  appear  like  dipsomaniacs  over- 
whelmed with  a  mad  craze  for  spirits  but  unlike 
this  class,  when  forced  by  adverse  circumstances 
and  with  apparent  objects  to  gain,  they  show 
remarkable  power  of  abstinence.  Others  of  this 
class  drink  in  favorablp  circumstances  only,  and 
abstain  when  their  interests  are  in  peril.  The 
drinking  seems  to  be  of  a  mental  as  well  as  a 
physical  type.  The  mind  recurring  to  alcohol  as  a 
help  when  the  conditions  are  favorable.  They  alter- 
nate between  extreme  condemnation  of  persons 
who  use  it,  and  childish  theories  and  explanations 
of  their  own  addiction.  They  are  filled  with  buo)'-- 
ant  and  most  extravagant  theories  of  the  methods 
of  relief  and  means  of  escape,  and  are  the  most 
devoted  advocates  of  all  new  remedies  and  means 
of  treatment.  Among  these  persons  the  mental 
element  will  often  develop  into  fixed  delusions 
of  the  necessity  of  alcohol  as  a  medicine,  and 
many  of  the  most  devoted  advocates  of  the  tonic 
and  stimulant  powers  of  alcohol  belong  to  this 
class.  Some  of  these  persons  use  wines  continu- 
ously, and  only  resort  to  alcohols  at  long  inter- 


18  DRUG   HABITS   AND   THEIR  TREATMENT. 

vals.  Such,  cases  become  elemented  after  a  time, 
and  are  noted  as  cranks,  paranoiacs  and  persons 
with  twisted  brains.  The}^  belong  to  the  eccen- 
tric class,  and  those  who  are  "uncertain,  unreliable, 
unstable,  and  likel}^  to  develop  into  more  pro- 
nounced forms  of  mental  disease. 

A  stud}'  of  the  causes  of  these  different  classes 
reveals  varied  and  complex  conditions.  When  the 
histories  of  a  large  number  are  carefully  gathered 
and  compiled,  it  is  found  that  over  sixty  per  cent 
have  inherited  from  their  parents  a  predisposition 
to  seek  for  some  relief  for  states  of  depression 
and  ill-feeling. 

HEEEDITT   AXD    FORMS    OF   PEEDISPOSITION". 

These  causes  are  divided  into  two  classes,  one 
called  direct  and  the  other  indirect.  The  direct 
heredities  are  those  where  the  parents  have  been 
moderate  or  excessive  drinkers.  The  indirect 
heredities  are  cases  where  grandparents  drank  or 
used  drugs. 

In  the  first  class,  there  is  often  a  direct  trans- 
mission from  parent  to  child  of  the  drink  impulse 
appearing  at  about  the  same  time  as  in  the  par- 
ent, following  a  uniform  course,  and  ending  in 
the  same  way. 

Example.  One  family  for  three  generations 
had  several  sons  in  each  branch  who  began  to 
drink  at  pubert}^,  and  either  died  or  became  total 


HABIT,  AND   THE  DAMAGES   OF  ALCOHOL.  19 

abstainers  at  about  thirty  years.  The  daughters 
in  these  families  were  drug-takers  and  alcoholics, 
hysterical,  and  epileptoid.  Some  of  them  died  in 
early  life  but  all  showed  marked  defects  of  brain 
and  nervous  system. 

The  rule  is  that  where  alcohol  takers  have 
large  families,  the  tendency  is  to  an  early  extinc- 
tion. The  defects  transmitted  seriously  impair 
longevity  under  the  most  favorable  conditions. 
Many  children  of  drinking  parents  are  total  ab- 
stainers until  some  serious  change  or  physical  rev- 
olution takes  place  in  their  organism;  then,  if 
alcohol  is  used,  they  become  impulsive  drinkers 
of  the  most  imbecile  type,  drinking  usually  to 
death.  Other  descendants  of  alcoholic  ancestors 
are  delusional  fanatics  in  their  conceptions  of  the 
drink  disease  and  their  theories  of  its  remedies. 

It  may  be  stated  as  a  rule  that  the  children  of  al- 
coholic parents  are  defectives,  and  will  often  use 
alcohol  with  or  without  any  particular  exposure. 
The  exceptions  to  this  only  indicates  a  change  in 
the  type  of  degeneration.  For  instance,  daughters 
of  alcoholized  parents  show  great  feebleness  of 
moral  faculties  and  become  prostitutes,  hysterics 
and  degenerates.  If  they  fortunately  escape  this, 
they  may  develop  in  later  life  some  of  the  manias 
■\\'hich  indicate  their  unsoundness. 

In  the  third  generation  from  the  alcoholized 
parents  extreme  types  of  weakness  with  mental  in- 


30  DRUG  HABITS  AND   THEIR  TREATMENT. 

capacity  and  physical  defects  appear.  Statistics 
of  the  criminal  and  degenerate  classes  show  a 
large  percentage  of  alcoholized  parents.  Morel, 
of  France,  has  made  a  table  of  this  decline  which 
can  be  stated  with  great  certainty  as  showing  the 
line  of  degeneration.  First  generation,  alcoholic 
excesses  with  immoralities  and  degradation.  Sec- 
ond generation,  early  drunkenness,  manias,  and 
general  palsies,  with  criminality  and  pauperism. 
Third  generation,  sobriet}'-,  hypochondria,  great 
feebleness  and  paralysis.  Fourth  generation,  men- 
tal feebleness,  idiocy  and  extinction. 

In  the  examination  of  a  large  number  of  cases, 
these  direct  heredities  of  persons  in  this  country 
seem  not  to  pass  beyond  the  second  generation. 
The  vitality  becomes  exhausted  and  early  death 
from  acute  and  chronic  disease  follows. 

The  general  principles  that  obtain  in  these  cases 
may  be  stated  as  follows :  All  children  of  inebri- 
ate parents  inherit  a  defective  vitality  with  feeble 
power  of  resistance  and  inability  to  adjust  them- 
selves to  the  surroundings.  These  conditions  of 
weakness  and  degeneration  diminish  the  power  of 
resistance  to  all  inflammatory  disease  and  make 
narcotism  from  alcohol  fascinating  because  it 
brings  with  it  a  feeling  of  strength  and  relief 
from  physical  and  mental  pain. 

Often  the  higher  moral  faculties  of  the  person 
are  undeveloped,  and  the  children  of  alcoholized 


HABIT,  AND   THE  DAMAGES   OF  ALCOHOL.  31 

persons  are  born  criminals  without  consciousness 
of  right  and  wrong,  and  with  a  feeble  sense  of 
duty  and  obligation. 

Another  curious  fact  is  that  the  children  of 
alcoholized  persons  often  show  great  fecundity  and 
have  large  families,  suggesting  the  oft-noted  fact 
that  just  before  the  extinction  of  the  race  Nature 
makes  a  supreme  effort  to  perpetuate  the  seed 
and  to  save  it  from  obliteration.  While  these  in- 
ebriates' families  are  often  large,  they  rarely  live 
through  childhood,  and  carry  into  maturity  defects 
which  soon  cause  their  extinction.  Families  of 
this  kind  are  by  no  means  uncommon.  The  gen- 
eral history  clearly  indicates  degeneration,  both  in 
appearance  and  conduct.  Tuberculosis,  hysteria, 
eccentricity,  rheumatism,  and  an  almost  endless 
variety  of  neuroses  appear.  Occasionally  some 
member  of  these  dying  families  will  be  brilliant 
and  precocious,  and  start  far  away  above  his  age 
and  generation  in  intellectual  development  and 
achievement  but  die  suddenly.  The  vast  major- 
ity comprise  the  dying  masses  or  as  it  is  popularly 
termed  "the  driven-out,  or  crowded-out  remnants 
of  the  race." 

The  indirect  heredities  are  equally  sta.rtling. 
Why  one  generation  of  sober  people  should  inter- 
vene, and  only  in  the  third  generation  the  defects 
of  the  grandparent  appear  is  difficult  to  under- 
stand.    In  the  figures  we  have  mentioned  the 


23  DRUG   HABITS   AND   THEIR  TREATMENT. 

indirect  heredities  will  be  from  a  third  to  a  half 
of  the  sixty  or  seventy  per  cent  of  cases.  In  all 
probability  some  form  of  defects  has  laid  dormant 
through  one  generation  and  breaks  out  in  the  third 
from  the  application  of  some  exciting  causes  or 
possibly  in  the  second  generation  there  was  an 
absence  of  these  causes.  Nearly  all  these  persons 
who  develop  alcoholism  in  the  third  generation 
also  exhibit  various  neurotic  troubles,  both  of  ner- 
vous system  and  nutrition,  also  a  tendency  to  rapid 
exhaustion. 

The  following  is  an  example:  An  inebriate  an- 
cestor had  four  children  who  were  temperate  and 
well.  Of  their  children,  eight  out  of  eleven  drank  at 
different  times,  four  of  them  dying  from  this 
cause,  the  others  becoming  demented  or  dying 
from  intercurrent  diseases.  Other  members  of  the 
family  were  neurotics  and  died  of  consumption  or 
broke  down  in  early  life  and  were  invalids. 

In  three  cases  under  my  care,  there  was  no  in- 
ebriety in  the  ancestors  but  in  the  grandparents 
on  both  sides  there  had  been  excessive  drinking. 
Each  of  these  cases  had  a  very  careful  training 
and  the  inebriety  did  not  break  out  until  middle 
life.  The  conditions  in  which  it  developed  pointed 
out  clearly  the  neurotic  inheritance.  There  is  no 
more  mystery  in  this  than  the  transmission  of 
physical  defects  from  one  generation  to  another  or 
the  skipping  of  one  generation  and  the  develop- 


HABIT,  AND   THE  DAMAGES    OF  ALCOHOL.  23 

ment  of  the  same  peculiarity  in  the  second  or  third 
generation. 

In  these  drug  diseases  there  is  probably  trans- 
mitted some  special  tendency  to  seek  relief  in 
some  way  from  psychical  and  physical  pain.  Al- 
cohol gives  the  most  positive  relief  of  all  other 
drugs.  There  is  also  transmitted  a  low  degree  of 
vitality  with  feeble  resisting  powers  to  pain,  and 
defective  control.  The  person  suffering  from 
nerve  or  mental  pain  is  unable  to  bear  discomfort 
and  becomes  possessed  with  the  impulse  to  secure 
relief  at  all  peril.  There  is  also,  no  doubt,  trans- 
mitted some  latent  predisposition  to  hyperaesthe- 
sia  and  exhaustion  of  the  nerve  centers  which  pro- 
voke morbid  impulses  to  overcome  them. 

NEUEASTHENIA  AND   OTHER   CAUSES. 

!N'ext  to  heredity  as  an  active  cause  in  inebriety, 
states  of  exhaustion  and  neurasthenia  are  most 
prominent.  The  use  of  drugs,  particularly  alco- 
hol, is  far  more  impulsive  and  precipitate  in  this 
country  than  elsewhere.  No  doubt  this  is  due  to 
the  intensity  of  living,  the  continuous  excitement 
and  rapid  change  in  life  and  living  occupying 
nearly  every  moment  of  the  time,  drawing  con- 
stantly on  the  energies  of  the  brain  and  body 
without  healthy  periods  of  rest.  To  this  is  added 
the  consequent  neglect  of  the  healthy  normal  func- 
tions of  the  body.    As  a  result  neurasthenia,  cere- 


24  DRUG   HABITS  AND   THEIR  TREATMENT. 

brasthenia,  and  other  profound  neuroses  lower  the 
vitality  of  the  body  and  produce  a  condition  of 
mental  pain  and  suffering  for  which  narcotic  drugs 
are  most  grateful.  Often  these  conditions  of  ex- 
haustion begin  in  early  life  and  are  intensified  by 
educational  training  and  bad  conditions  of  living. 
The  overworked  and  those  who  have  a  large  burden 
of  cares  and  exacting  duties,  and  who  neglect  to 
live  in  accord  with  the  requirements  of  their  life, 
soon  exhaust  their  vitalities  and  become  early  vic- 
tims. They  become  drug-takers,  finding  most 
ready  relief  in  'T)itters"  and  remedies  containing 
alcohols,  and  soon  abandon  these  for  the  various 
compounds  of  strong  liquors. 

There  are  others  who  become  neurotic  from  bad 
surroundings,  suffer  from  shocks,  both  physical 
and  mental,  and  have  stages  of  extreme  depression 
in  which  alcohol  is  a  grateful  remedy. 

The  perturbations  and  changes  of  puberty  are 
often  fatal  periods  for  the  development  of  this 
predisposition.  The  disasters  and  storms  of  later 
life  have  the  same  effect. 

The  failures  of  nutrition,  conditions  of  starva- 
tion, with  anemia  and  insomnia,  are  all  active 
causes. 

There  are  a  number  of  persons  in  every  com- 
munity who  are  constitutionally  sensitive  to  their 
surroundings.  They  seem  to  refiect  the  company 
they  are  associated  with  as  well  as  the  hygienic 


HABIT,  AND   THE  DAMAGES  OF  ALCOHOL.  25 

conditions  they  live  in,  and  are  subject  to  every 
fluctuation  of  both,  mental  and  physical  condi- 
tions of  life.  Such  persons  are  intemperate  or 
temperate  according  to  the  presence  of  temptation 
or  absence  of  it. 

Inebriates  of  this  class  are  called  contagious 
inebriates. 

Where  the  causations  are  clearly  physical,  they 
early  become  chronic  and  develop  serious  disease. 
Such  persons  are  usually  neurotics  of  the  hyper- 
esthetic,  emotional  class.  They  often  possess 
genius  but  are  impulsive,  unreasoning  and  credu- 
lous, accepting  the  conclusions  of  the  present  with- 
out doubt  or  question,  and  also  seem  to  be  gov- 
erned entirely  by  present  impressions.  In  com- 
pany with  drinking  men  they  imitate  them.  With 
abstainers,  they  are  abstinent,  and  never  seem  to 
realize  that  they  cannot  do  as  others  do  without 
suffering.  Many  of  this  class  are  wanting  in  cul- 
ture and  training.  Often  they  come  from  indul- 
gent family  circles  where  every  wish  has  been 
gratified.  In  other  circles  where  they  have  been 
isolated,  and  seldom  come  in  contact  with  new 
persons  and  conditions  of  life,  they  become  mere 
imitators,  and  do  not  seem  to  be  able  to  adapt 
themselves  to  any  new  conditions  but  are  molded 
by  the  surroundings  entirely.  Such  persons  are 
often  described  as  "sowing  wild  oats"  at  this  time. 


36  DRUG   HABITS  AND   THEIR  TREATMENT. 

and  from  bitter  experience  acquire  certain  predis- 
positions which  are  fatal  through  all  after  life. 

Parents  and  guardians  are  more  responsible  for 
this  condition  than  the  victims  themselves.  Young 
men  and  women  with  this  pliable  contagious  men- 
tality require  more  than  school  and  home  train- 
ing. They  need  to  be  under  the  control  and  direc- 
tion of  robust  and  controlling  minds  for  a  long 
time. 

As  inebriates  such  persons  early  become  de- 
mented and  fall  into  pauperism  and  petty  crimes, 
rarely  becoming  criminals  except  of  the  lowest 
type. 

As  patients,  nothing  but  a  revolution  of  sur- 
roundings and  conditions  of  living  will  be  of  any 
advantage.  They  are  subject  to  every  new  method 
of  treatment,  and  bec^ome  restored  and  pose  as  ex- 
amples of  cure  from  every  condition  and  method 
of  treatment.  Then  they  relapse  as  quickly,  and 
seem  so  thoroughly  identified  with  the  surround- 
ings that  it  is  difficult  to  classify  them. 

Types  of  the  two  classes  are  apparent  in  the 
following  examples: 

A ,  the  only  son  of  an  excellent  clergyman, 

was  brought  up  without  the  slightest  control,  and 
every  whim  was  gratified.  In  college  he  fell  in 
with  drinking  companions,  and  drank  to  great  ex- 
cess. Later,  as  a  merchant,  he  drank  in  company, 
and  wherever  he  went  seemed  to  follow  the  habits 


HABIT,  AND   THE  DAMAGES   OF  ALCOHOL.  27 

and  practices  of  those  he  was  associated  with. 
He  was  converted  frequently,  signed  the  pledge  on 
many  occasions,  went  to  several  asylums,  came 
away  restored — only  to  relapse  when  brought  in 
contact  with  drinking  company.  Finally,  at  thirty 
years  of  age,  he  was  sentenced  to  prison  as  an 
accessory  to  murder.  He  is  there  at  present,  and  is 
a  most  reputable  prisoner,  allowed  great  liberties, 
and  is  an  active  man  in  his  place. 

The  exact  surroundings  and  prison  discipline 
have  brought  him  to  a  higher  standard  of  living 
than  he  has  had  before.  When  his  sentence  is  fin- 
ished he  will  be  employed  in  the  prison,  and  prob- 
ably will  live  a  useful,  temperate  life. 

Example  ISTo.  2  is  that  of  a  farmer's  son,  brought 
up  in  the  interior,  isolated,  and  seldom  coming 
in  contact  with  other  persons.  At  twenty  he  pro- 
cured a  situation  in  a  large  city,  and  soon  became 
an  inebriate,  and  drifted  from  place  to  place,  hav- 
ing no  individuality — simply  following  every  influ- 
ence which  is  brought  to  bear  on  him.  Finally, 
ten  years  later,  he  became  a  servant  of  a  vigorous 
man  who  realized  his  flaccid  character,  and  treated 
him  with  great  severity,  forcing  him  to  live  in 
correct  surroundings  and  away  from  bad  company. 
He  remained  here  many  years  and  was  a  temper- 
ate, valuable  man.  Then  his  employer  died,  and  in 
another  situation  he  became  a  drinker  and  soon 
relapsed  and  died. 


«o  DRUG   HABITS   AND   THEIR  TREATMENT. 

Both  of  these  eases  are  types  of  a  class  of  per- 
sons who  in  certain  surroundings  could  be  made 
useful  citizens,  and,  acting  under  the  control  and 
dictation  of  others,  might  be  free  from  all  use  of 
drink. 


DIPSOMANIA.  39 

CHAPTER  II. 

DIPSOMANIA. 

Dipsomania^  as  its  name  implies,  is  an  insane 
thirst  or  craze  for  alcohol.  This  disease  is  not 
very  common,  and  frequently  appears  without 
premonition.  Such  persons  have  used  spirits  in 
moderation  or  at  intervals,  rarely  to  stupor,  and 
are  considered  temperate.  Suddenly,  without  ap- 
parent cause,  they  will  be  possessed  of  an  insane 
desire  to  procure  spirits  and  drink  to  stupor.  On 
recovery  after  an  interval  the  mania  comes  on 
again,  and  another  period  of  narcotism  follows. 
This  continues  several  days  until  complete  ex- 
haustion, gastritis,  and  delirium  supervenes. 
Then  a  long,  irregular  period  of  rigid  abstinence 
follows. 

This  differs  widely  from  the  periodical  drinker 
in  coming  on  suddenly  and  possessing  the  body 
like  a  veritable  mania  in  which  no  other  thought 
or  motive  exists  except  to  procure  spirits. 

It  is  an  insanity  of  the  impulsive  t5rpe,  and  has 
a  distinct  beginning,  progress,  and  termination; 
and  is  certain  to  end  in  recovery.  Such  persons 
are  dangerous  when  opposed  but  harmless  when 
permitted  to  use  spirits.  Delirium  tremens  is  not 
often  associated  with  this  although  some   cases 


30  DRUG   HABITS    AND    THEIR   TREATMENT. 

have  been  called  delirium  tremens.  The  impetn- 
osity  of  the  impulse  and  its  overmastery  of  the 
mind  and  body  is  illustrated  in  many  striking 
cases. 

In  one  instance  a  man  chopped  off  his  hand  for 
the  purpose  of  procuring  spirits  as  a  medicine  for 
the  shock. 

During  the  Civil  AYar.  a  sutlers  vragon  with  a 
barrel  of  Tvhiskey  was  broken  down  between  the 
lines  within  easy  range  of  the  sharpshooters  on 
both  sides.  The  certainty  of  instant  death  did  not 
deter  men  on  both  sides  from  attempting  to  reach 
the  barrel  to  procure  spirits.  After  a  number  of 
men  had  been  killed  a  cannon  was  brought  up  to 
destroy  the  barrel. 

Men  have  been  known  to  deed  away  their  prop- 
erty for  spirits  under  this  impulse.  Some  famous 
trials  have  followed  from  acts  committed  during 
this  period.  A  noted  statesman  had  dipsomaniac 
impulses  which  were  controlled  by  placing  him  in 
a  cell  for  forty-eight  hours.  Others  have  been 
given  spirits  to  stupor  until  the  impulse  died  away. 
Many  of  these  cases  become  opium-eaters  or  have 
died  from  the  effects  of  narcotic  drugs  given  to 
check  the  impulse.  "When  the  craze  subsides  a 
period  of  extreme  exhaustion  follows,  without  delu- 
sions or  hallucinations:  the  mind  seems  to  be  clear 
again.  Some  authors  think  that  this  condition  is 
more  common  among  women  than  men.     In  my 


DIPSOMANIA.  31 

experience  it  is  of  shorter  duration  and  more  easily 
checked  in  women.  In  some  of  these  cases  where 
the  impulse  is  forcibly  restrained  by  drugs  it 
breaks  out  again  with  greater  force  than  ever. 
Active  treatment  should  be  continued  for  some 
time  after  the  subsidence  of  the  impulse.  There 
is  associated  with  this,  loss  of  appetite,  excessive 
perspiration,  increased  heart's  action  and  slightly 
raised  temperature  of  the  body.  Insomnia  and  in- 
tense muscular  and  mental  activity  are  also  com- 
mon symptoms. 

These  attacks  usually  follow  each  other  at  irreg- 
ular intervals,  depending  upon  unknown  causes, 
but  no  doubt  due  to  some  central  irritation  and 
exhaustion.  All  periodic  drinkers  are  not  dipso- 
maniacs, and  very  few  inebriates  can  be  classed 
under  this  head.  Many  of  these  persons  go  to 
the  insane  asylums  before  the  paroxysm  subsides, 
and  afterward  are  very  clamorous  to  be  released, 
claiming  that  they  have  been  unjustly  confined. 
The  following  is  an  example :  A  lawyer  supposed 
to  be  temperate,  though  he  had  occasionally  used 
spirits  in  company  and  at  banquets,  suddenly 
developed  this  impulse  following  a  period  of  in- 
tense excitement.  He  wandered  about  the  streets, 
drinking  at  all  times  and  places  in  the  most  mani- 
acal way,  giving  no  reason  for  his  conduct,  simply 
saying  that  he  must  drink.  He  was  forcibly  re- 
strained, and  developed  maniacal  violence,  and  was 


32  DRUG   HABITS   AND   THEIR   TREATMENT. 

taken  to  an  insane  asylum.  He  recovered,  was  dis- 
charged, and  commenced  action  for  false  impris- 
onment. Two  5''ears  after,  following  a  political 
campaign  during  which  he  was  abstinent,  the  same 
impulse  came  on,  lasting  about  a  week,  during 
which  time  he  was  continuallj^  stupid  or  wildly 
delirious,  having  no  other  thought  on  his  mind 
but  drink  continuously.  He  eventually  became 
insane,  and  died  in  an  asylum.  Physicians  who 
treat  cases  in  prisons  notice  the  outbreak  of  this 
impulse  among  the  inmates,  often  manifest  in  a 
dazed,  delirious  condition,  with  continuous  talk 
of  drink  and  effort  to  procure  it  in  some  form. 

Such  cases  have  done  themselves  injury  for  the 
purpose  of  getting  into  the  hospital,  hoping  to 
procure  spirits  as  a  medicine.  They  are  often 
confined  in  a  strait- jacket  during  these 
periods,  and  it  is  often  a  difficult  question  to  de- 
cide whether  to  restrain  them  or  to  permit  this 
impulse  to  be  gratified. 

DELIEIUil   TREMENS. 

Much  confusion  exists  concerning  delirium  tre- 
mens. In  reality  the  term  should  be  applied  to 
persons  who  have  delirium  associated  'ndth  mus- 
cular trembling,  and  hallucinations  and  delusions. 
Many  cases  of  delusions  without  muscular  dis- 
turbance are  cases  of  alcoholic  delirium  of  short 
duration ;  and  when  not  overtreated,  recover  with- 


DIPSOMAMA.  33 

out  serious  sequelas.  In  delirium  tremens  there 
appears  to  be  profound  exhaustion  and  irritation 
of  all  the  nerve  centers^  affecting  both  the  sensor}' 
and  motor  centers  of  the  body.  It  is  always  asso- 
ciated with  neurites  of  the  nerves  of  the  extremi- 
ties, and  seems  to  be  a  complex  poison  case  ijj 
which  both  the  poisons  of  alcohol  and  the  toxins 
formed  in  the  system  are  combined.  It  usually 
follows  a  prolonged  period  of  excessive  use  of 
spirits,  particularly  where  the  person  has  neglected 
the  nutrition  of  the  body  and  has  been  subjected  to 
great  strain,  both  mental  and  physical,  with  ex- 
haustion. The  onset  is  marked  by  hallucinations 
and  delusions  with  failure  of  muscular  co-ordina- 
tion. Sometimes  symptoms  of  acute  neuritis  pre- 
cede the  attack,  marked  by  shooting  pains,  numb- 
ness, prickling  sensations  and  formication.  The 
muscular  control  of  the  hands  and  extremities  will 
be  enfeebled,  and  more  spirits  will  be  taken  to 
counteract  these  effects,  which  are  often  ascribed 
to  other  than  the  real  causes.  Then  insomnia,  ex- 
altation and  profuse  perspiration  will  come  on. 
For  all  these  physical  conditions  more  spirits  wiU 
be  taken.  Sounds  'wiR  be  heard  and  double  ob- 
jects will  appear  to  the  vision.  These  will  soon 
develop  into  hallucinations  and  delusions  which 
become  more  and  more  fixed.  The  muscular  agi- 
tation will  increase,  and  the  mind  will  become 
alarmed  at  the  apparent  reality  of  the  horror  of 


34  DRUG   HABITS   AND   THEIR   TREATMENT. 

the  situation.  These  cases  are  usually  self -limited, 
and  when  treated  with  eliminatives  and  controlled, 
will  recover  in  ten  days  or  two  weeks.  The  hallu- 
cinations and  delusions  gradually  pass  away,  the 
muscular  trembling  and  agitation  going  first.  The 
serious  danger  in  these  cases  is  over-medication, 
both  from  overfeeding  and  excessive  use  of  drugs. 

Alcoholic  delirium  begins  Avith  slight  defects 
of  reason  and  sensory  changes  growing  gradually 
into  certain  fixed  conditions,  without  muscular 
disturbance  or  much  digestive  changes.  It  usually 
comes  on  from  prolonged  use  of  spirits,  associated 
with  excitement.  It  often  occurs  among  persons 
who  are  overfed,  gourmands  and  idlers,  and  in 
underfed,  anemic  persons.  Frequently  the  con- 
tinuous use  of  wines  brings  on  this  condition,  par- 
ticularly champagne,  the  brain  being  seemingly 
unable  to  recover  from  the  continuous  irritation 
and  depression  which  follows.  It  may  be  stated  in 
a  general  way  that  beer  and  wine  are  more  active 
in  the  causation  of  alcoholic  delirium  than  whiskey 
or  brandy. 

There  are  difEerent  forms  of  delirium  in  which 
delusions  seem  to  be  prominent,  the  senses  often 
remaining  partially  intact,  the  delusions  having 
reference  to  outside  matters  and  possessing  the 
brain  to  the  exclusion  of  all  other  thoughts.  There 
are  milder  stages  of  the  same  condition  which  are 
amenable  to  treatment,  and  are  self-limited.    The 


DIPSOMANIA.  35 

delusions  may  remain  a  very  long  time,  even  after 
recovery  and  long  abstinence.  They  indicate, 
without  doubt,  some  lesion  of  the  brain  which  is 
not  restored  by  the  removal  of  the  active  cause. 

Many  of  these  cases  become  paranoiacs  and  show 
mental  disturbances  for  the  remainder  of  their 
active  lives.  Others  recover  and  seem  but  little 
changed. 

Experience  shows  that  the  presence  of  de- 
lirium, either  in  pronounced  delirium  tremens  or 
the  lighter  forms,  is  most  serious  in  its  effects  on 
the  brain,  recovery  rarely  taking  place  without 
leaving  entailments  and  defects  that  are  noticeable 
in  all  after  life.  Even  slight  attacks  of  delirium 
have  been  followed  by  changes  of  character  and 
conduct  that  grew  to  serious  proportions  later. 

There  can  be  no  doubt  that  the  tendency  to  a 
recurrence  of  these  conditions  is  greatly  increased 
after  the  first  attack.  Hallucinations  and  delu- 
sions are  more  likely  to  occur  than  before.  Some- 
times an  old  delusion  entertained  in  a  former  at- 
tack reappears  again  with  greater  intensity.  Hal- 
lucinations also  come  on  again  of  the  same  char- 
acter as  before. 

The  pathological  condition  is  one  of  poisoning 
and  local  degeneration  of  cells  and  perversion  of 
cell  force,  and  often  indicates  profound  changes 
both  functional  and  organic.  It  is  always  well  to 
take  into  consideration  the  possibility  of  the  com- 


36  DRUG  HABITS   AND   THEIR   TREATMENT. 

plication  of  syphilis  in  these  cases.  It  undoubtedly 
modifies  the  form  and  duration  of  the  delirium. 
In  all  cases  the  damage  which  accrues  from  these 
two  poisons  should  never  be  minimized.  In  med- 
ico-legal cases  it  is  safe  to  assume  that  the  fact 
of  having  had  delirium  from  alcohol  is  positive 
evidence  of  mental  impairment. 

No  case  presents  a  uniform  class  of  symptoms 
except  in  some  very  general  particulars.  Wide 
variations  will  constantly  appear.  In  some  in- 
stances defects  of  sight  will  be  most  prominent; 
all  the  other  symptoms  will  be  negative.  In  others, 
hallucinations  of  hearing  will  be  the  leading  symp- 
tom. SjDecial  delusions  of  snakes  and  grotesque 
objects  are  not  always  present  and  may  be  only 
transient.  Scm^e  persons  have  grandiose  delusions. 
Others  suffer  from  fears  of  unseen  disasters.  One 
man  was  alarmed  lest  the  house  should  fall  upon 
him.  Another,  that  an  earthquake  would  swallow 
him  up.  A  third,  that  he  would  be  struck  by 
lightning  or  destroyed  in  a  hurricane.  Sometimes 
the  delusions  refer  to  business  matters  or  to  so- 
cial events,  to  family  and  friends  or  to  politics  or 
religion.  They  are  usually  transient  but  some- 
times take  on  permanent  forms  which  influence 
the  mind  ever  after. 

It  is  difficult  to  differentiate  many  of  these 
eases  from  well-known  forms  of  insanity,  and  it  is 
justifiable  for  the  physician  to  treat  them  as  such. 


DIPSOMANIA. 


37 


using  practically  the  same  means  and  measures, 
only  recognizing  the  poison  causes  as  most  prom- 
inent. Some  of  these  cases  have  convulsions  after  a 
prolonged  period  of  intoxication  which  resemhle 
epilepsy,  and  are  called  alcoholic  epilepsy.  They 
have  many  of  the  features  of  a  true  epilepsy,  only 
the  duration  is  shorter,  and  rarely  any  stupor  fol- 
lows. Local  paralyses  are  very  common  after  these 
conditions,  and  gi-eat  depression  of  spirits  amount- 
ing in  some  cases  to  melancholia. 

The  suicidal  cases  of  alcoholism  undouhtedly 
occur  after  these  convulsive  attacks.  In  many 
instances  homicides  have  occurred  where  the  pa- 
tient was  opposed  or  where  some  delusion  of  in- 
jury existed  and  a  feeling  of  revenge  followed. 
The  melancholia  which  follows  these  convulsive 
attacks  is  often  associated  with  intense  activity  of 
certain  ideas  or  delusional  conceptions.  It  is  in 
this  condition  that  crime  may  be  committed.  Some 
wrong  or  supposed  injury  of  the  past  will  suddenly 
break  out  into  great  activity  or  perhaps  a  suicidal 
impulse  which  has  occurred  long  ago  will  become 
prominent  again. 

Hallucinations  of  the  senses  rarely  occur.  The 
disturbances  are  mostly  confined  to  delusions. 
Many  of  these  impulses  and  false  beliefs  pass  away 
by  active  treatment,  and  seemingly  depend  upon 
some  disordered  state  of  digestion  or  condition  of 
exhaustion. 


38  DRUG   HABITS   AND   THEIR   TREATMENT. 

Convulsions  following  excess  of  alcohol  always 
leave  a  serious  entailment  on  the  brain  and  ner- 
vous S3''stein  which  is  manifest  in  various  physical 
and  mental  defects.  In  some  cases  these  convul- 
sions increase  and  become  veritable  epilepsies  of 
the  classic  type.  If  it  can  be  ascertained  that  it 
was  purely  of  alcoholic  origin,  the  prognosis  and 
treatment  will  vary  from  that  of  traumatic  epi- 
lepsy. A  few  cases  have  been  reported  of  convul- 
sions following  the  use  of  opium,  but  in  all  prob- 
ability some  latent  condition  of  the  system  favor- 
ing this  state  had  existed  before  the  drug  was 
taken.  Absinthe  and  "bitters"  composed  of  strong 
alcoholic  extracts  when  taken  in  excess  have  pro- 
duced convulsive  conditions  wliich  differ  from 
the  ordinary  alcoholic  epilepsies.  There  is  more 
delirium  present  and  intense  physical  and  mental 
depression,  ending  in  maniacal  states;  hence  the 
use  of  these  forms  of  spirits  is  more  dangerous. 

Magnan  found  in  100  cases  of  mania  40  which 
had  used  these  alcoholic  liqueurs.  He  described  a 
form  of  mania  due  to  this  cause.  In  this  coun- 
try this  is  rare,  and  when  absinthe  is  taken  the 
symptoms  are  more  of  the  melancholic  type. 

OTHER    CAUSES. 

The  general  impression  is  that  bad  surround- 
ings and  company  are  the  most  frequent  causes  of 
the  drug  habits.    This  is  not  sustained  by  a  study 


DIPSOMANIA.  39 

of  cases.  It  is  found  that  most  cases  have  a  range 
of  causes  farther  back,  and  that  surroundings 
and  company  are  only  incidental  and  associate  con- 
ditions. Persons  who  use  spirits  suffer  from  pal- 
sies of  the  moral  brain,  and  are  not  disturbed  by 
low  company  and  bad  surroundings.  The  action 
of  spirits  creates  a  tolerance  and  liking  for  bad 
company  and  surroundings.  This  gives  the  im- 
pression of  being  the  real  cause — in  reality  it  is 
only  the  effect.  It  may  be  the  first  cause  among 
those  predisposed  and  with  feeble  personality;  it 
then  acts  as  an  exciting  influence,  but  in  most  cases 
it  is  secondary. 

In  a  large  proportion  of  cases  certain  predispos- 
ing and  favoring  conditions  are  present.  Of  these 
heredity  explains  the  largest  number.  In  a  study 
of  many  thousand  cases  over  60  per  cent  are 
found  to  have  inebriate  ancestors.  In  40  per  cent 
of  these,  both  parents  have  used  spirits.  In  15  or 
20  per  cent  the  grandparents  on  both  sides  were 
spirit  takers.  In  the  remaining  number  are  cases 
in  which  one  of  the  parents  or  grandparents  have 
drank. 

Injury  and  disease  are  found  to  be  the 
next  largest  factors  in  the  causation.  Then  comes 
dietetic  disturbances  and  exhaustion,  both  mus- 
cular and  mental  as  early  causes.  Beyond  this 
there  is  a  certain  unknown  field  of  causes  which 
includes  almost  every  condition  of  obscure  strain 


40  DRUG   HABITS   AND   THEIR   TREATMENT. 

and  drain.  Of  the  liereditaiy  causes  the  facts  are 
apparent  in  any  general  observation.  What  prob- 
ably is  transmitted  is  a  predisposition  to  seek  relief 
from  some  condition  of  exhaustion  or  defective 
vitality.  Also  there  is  no  doubt  a  low  degree  of 
vital  force  with  feeble  power  of  restoration  often 
manifest  at  puberty^  wliich  calls  for  spirits. 
Later  in  life  under  any  conditions  of  strain  the 
same  sense-fatigue  appears  calling  for  help.  In 
some  instances  this  predisposition  is  manifest 
in  taste  enjoyment.  Both  the  odors  and  flavors 
of  spirits  are  agreeable  and  sought  for.  Many 
persons  have  this  inheritance^  which  is  not  de- 
veloped into  spirit-taking. 

Often  inherited  cases  show  general  marks  of 
defect^  both  mentally  and  physically,  which  are 
apparent  from  general  observation.  Atavism  or 
the  skipping  of  one  or  two  generations  of  this  in- 
heritance is  not  uncommon.  Such  cases  usually 
break  out  suddenly  without  any  tangible  or  prom- 
inent causes,  and  become  so  precipitate  and  pro- 
nounced as  to  suggest  a  far-off  iuheritance.  They 
are  usually  incurable,  developing  other  neuroses 
or  dying  early  from  some  concurrent  disease. 

These  cases  of  heredity  are  all  noted  for  the  pro- 
found degeneracy  which  follows  from  the  use  of 
alcohol  even  in  small  quantities.  Dr.  Kerr  be- 
lieved that  there  was  more  mental  derangement, 
a  stronger  tendency  to   delirium  and  delusional 


DIPSOMANIA.  41 

states  in  inherited  eases  than  in  others.  This  has 
been  confirmed  by  French  observers.  Magnan 
wrote  that  the  inlierited  cases  suffered  from  con- 
vnlsions  and  conralsive  disturbances.  This  is  sus- 
tained by  observations  in  this  country. 

I  have  found  inherited  cases  more  liable  to  take 
intercurrent  diseases  and  to  suffer  from  ordinary 
inflammations  and  to  have  a  greater  mortality. 
It  is  evident  that  such  cases  are  more  serious  and 
require  longer  treatment  and  are  more  likely  to 
have  complications. 

INJUEIES  AS  CAUSES. 

The  next  general  group  of  causes  which  seem 
to  follow  from  diseases  and  injuries  are  less  prom- 
inent and  seldom  observed.  Of  these,  physical  in- 
juries will  be  found  prominent,  such  as  concus- 
sions of  the  brain  and  cord,  blows  on  the  head  or 
sudden  physical  shocks  overwhelming  the  nervous 
system,  followed  by  profound  reaction.  Altera- 
tions of  nutrition  frequently  follow  these  states 
and  also  profound  exhaustion  for  which  spirits 
give  relief.  Blows  on  the  head  have  frequently 
been  followed  by  dipsomania  and  periodical  in- 
ebriety. Shocks  and  mental  perturbations  seem 
to  develop  delusional  states  after  spirits  have  been 
used.  Some  of  these  cases  have  become  noted  in 
literature.  A  prominent  physician  was  thrown 
from  a  carriage,  striking  on  his  head,  receiving 


43  DRUG  HABITS  AND   THEIR  TREATMENT. 

a  simple  scalp  wound.  Soon  after  he  developed 
inebriety  of  a  dipsomaniac  character,  which  ended 
in  his  death  in  an  asylum.  A  chaplain  in  the 
Civil  War  was  injured  by  a  shell  and  soon  after 
became  a  continuous  drunlcard,  dying  later,  having 
caused  a  great  deal  of  distress  among  liis  friends. 
In  both  these  cases  the  causes  were  unknown,  and 
the  injury  was  not  supposed  to  have  any  influence 
in  the  drunkenness  which  followed.  Peripheral 
irritation  has  been  noted  as  a  cause  in 
some  cases.  Tapeworms  have  excited  inebriety. 
Their  removal  was  followed  by  total  abstinence. 
The  irritation  from  j)rolonged  lactation  or  in  dys- 
menorrhoea,  amenorrhoea,  and  disturbances  of  the 
genital  organs  has  been  followed  by  the  drink 
craze. 

PREVIOUS  DISEASES  AS  CAUSES. 

Previous  diseases  are  active  causes.  Some  con- 
ditions of  exhaustion  follow,  or  defects  of  the  ner- 
vous system  which  call  for  relief.  Probably  states 
of  neurasthenia  and  cerebrasthenia  are  pres- 
ent. Intermittent  and  malarious  fevers  frequently 
precede  excessive  use  of  spirits.  Attacks  of  acute 
rheumatism,  diseases  of  the  skin,  and  renal  dis- 
turbances precede  the  drink  craze.  Dietetic  dis- 
eases are  often  associated  as  causes  owing  to  the 
intimate  association  between  the  nutritive  func- 
tions and  the  nervous  system.  Practically  any  dis- 
ease influencing  the  nutritive    functions    is    fol- 


DIPSOMANIA.  43 

lowed  by  exhaustion  of  which  inebriety  is  the  nat- 
ural sequence.  Irregularity  of  life  and  living  is 
followed  by  the  same  condition.  Sudden  excite- 
ment and  exhaustion;,  intense  mental  activity  from 
violent  emotions,  are  all  pregnant  causes.  These 
and  other  general  conditions  of  debility  are  to  be 
sought  for  in  a  study  of  the  early  causes.  It  is 
not  so  clear  how  surroundings  unhealthy  and  ab- 
normal act  in  this  way,  but  undoubtedly  they  have 
a  strong  influence  by  lowering  the  vital  forces  and 
creating  an  abnormal  impulse  for  relief. 

Some  very  interesting  studies  have  been  made 
on  the  effects  of  winds  and  the  elevations  above 
the  sea-level.  Cases  have  been  noted  where  per- 
sons living  at  the  sea-level  could  not  resist  the 
temptation  of  drink,  but  going  to  the  mountains 
several  thousand  feet  above  the  sea-level  they 
were  total  abstainers  without  efl'ort.  Persons  liv- 
ing in  these  high  levels  and  drinking  excessively 
have  been  able  to  abstain  by  going  down  to  the  sea- 
level.  High,  dry  winds  and  moist,  damp  winds, 
apparently  have  the  same  influence,  either  excit- 
ing the  drink  craze  or  depressing  it. 

Certain  sections  of  the  country,  particularly 
river  bottoms,  are  noted  for  their  large  number  of 
drinking  people,  while  adjoining  towns  on  higher 
levels  show  but  very  few  people  of  this  class.  It  is 
difiicult  to  account  for  these  conditions,  but  prob- 
ably some  state  of  exhaustion  is  encouraged  in 


44  DRUG   HABITS   AND   THEIR   TREATMENT. 

these  different  conditions  of  living  which  is  mani- 
fest in  the  drink  craze. 

It  is  a  disputed  question  how  far  adversity  is  an 
exciting  cause  of  the  drink  habit.  A  number  of 
cases  are-  reported  where  inebriety  seemed  to 
follow  directly  from  conditions  of  adversity.  In 
all  probability  in  most  of  these  cases  some  pre- 
disposing conditions  existed  which  were  roused 
into  activity  by  the  depression  of  adversity  and 
other  states. 

Sun  and  heat  strokes  are  very  often  early  causes 
of  this  condition.  Common  instances  are  those 
overcome  by  the  heat  who  are  given  spirits  by  some 
officious  friend,  and  become  comatose.  They  are 
then  taken  to  the  station  as  intoxicated,  and  later 
are  found  dead,  the  sunstroke  not  having  been 
recognized.  Many  of  these  cases  become  delirious 
after  a  glass  or  more  of  spirits,  and  are  called 
"'crazy  drunlv."  They  resist  arrest  and  are  fre- 
quently hit  on  the  head  by  a  policeman's  club,  and 
later  are  found  dead  in  the  cell,  and  the  examina- 
tion reveals  cerebral  hemorrhage.  The  history  of 
the  case  is  that  of  simply  insolation  and  delirium 
from  the  brandy  given,  and  the  hemorrhage  is 
the  direct  result  of  the  blow  by  the  policeman's 
club.    The  real  cause  is  not  ascertained. 

It  is  always  dangerous  to  administer  spirits  to 
one  found  comatose  on  the  street.  Heat 
apoplexies  are  very  intimately  associated  as  causes. 


DIPSOMANIA. 


45 


and  are  followed  by  inebriety.  Beyond  this  there 
are  innumerable  exciting  and  predisposing  con- 
ditions, not  only  incident  to  our  civilization  but  to 
the  tremendous  activities  and  strains  common  to 
every  active  life. 

PATHOLOGY. 

The  general  pathology  of  these  conditions  is 
that  of  cell-poisoning  and  nerve  esliaustion.  These 
conditions,  with  infinite  variations  and  complica- 
tions affecting  every  organ  of  the  body,  are  present 
in  all  cases.  Eecent  examinations  have  shown 
degenerations  of  nerve  tissue  and  fibrinous  pro- 
liferation with  thickening^,  of  the  walls  of  the  heart 
and  arteries. 

Both  the  liver  and  kidneys  suff'er  from  fatty 
degenerations. 

Local  hemorrhages  in  the  brain  are  more  or 
less  common,  followed  by  cutting  off  of  certain 
areas  from  activity,  and  resulting  in  local  palsies. 

The  direct  eft'ect  of  alcohol  has  been  summed 
up  by  Dr.  Taxy  in  the  following  statements: 

First,  it  impoverishes  the  blood  by  diminished 
oxidization  and  retarded  circulation. 

Second,  it  destroys  the  blood  corpuscles  and 
lessens  their  oxygen-carrying  properties. 

Third,  it  produces  vaso-motor  paralysis  and  im- 
paired reflex  action. 

J^umerous  experiments  of  the  action  of  alcohol 


46  DRUG    HABITS   AND    THEIR    TREATMENT. 

on  animals  have  brought  out  many  curious  facts 
of  the  forms  of  degeneration  which  follow,  and 
the  statement  has  been  made  by  eminent  author- 
ities that  alcohol  in  the  system  is  one  of  the 
most  dangerous,  corroding  substances  known. 

TEEATMENT. 

The  treatment  of  inebriety  will  depend  very 
largely  on  the  causes,  both  predisposing  and  con- 
tributing. When  these  are  ascertained  accurately, 
the  indications  of  what  to  do  will  be  clear.  Thus, 
if  it  is  apparent  that  inebriety  depends  on  irrita- 
tion from  reflex  action,  the  removal  of  this  cause 
is  the  first  essential.  If  it  is  the  result  of  shock 
or  injury  favorable  conditions  must  be  sought  for 
to  lessen  the  effects  of  these.  If  dietetic  and  nu- 
.  tritional  diseases  and  sexual  irritations  are  present 
and  have  preceded  the  drink  craze,  they  will  re- 
quire attention.  If  the  drink  craze  is  only  a  symp- 
tom of  organic  disease  or  another  phase  of  some 
form  of  insanity,  the  treatment  will  also  be  differ- 
ent. If  contagion  of  company  and  surroundings  are 
active  causes  or  states  of  exhaustion  'vith  excessive 
drains  and  strains,  all  these  require  special,  appro- 
priate remedies. 

Only  general  principles  can  be  laid  down  in 
the  matter  of  treatment  as  each  case  must  be 
a  law  to  itself.  In  one,  the  effects  of  alcohol  are 
very  prominent;  in  the  other,  alcohol  has  simply 


DIPSOMANIA.  47 

developed  some  states  of  degeneration.  Thus, 
excessive  use  of  spirits  is  a  symptom  of  general 
paralysis,  and  not  the  disease  itself.  In  another 
case,  the  craze  for  liquor  is  a  symptom  of  mania 
or  delusional  melancholia;  in  another  epileptoid 
conditions  manifest  themselves  in  impulsive  drink 
crazes;  in  a  third  senile  dementia  develops  the 
drink  craze. 

The  removal  of  spirits  can  always  be  done  at 
once  with  safety.  There  is  no  danger  of  any  ex- 
haustion from  sudden  withdrawal. 

Frequently  this  is  followed  by  other  symptoms 
not  noticed  before  and  marked  by  the  use  of  alco- 
hol. The  most  common  example  is  that  of  tubercu- 
losis, which  appears  and  goes  on  with  great  activity 
when  the  alcohol  is  removed.  The  acute  symp- 
toms seemingly  have  been  masked  while  the  spirits 
were  taken.  These  are  the  cases  which  develop 
acute  pneumonia  and  die  in  a  few  hours.  A  post- 
mortem shows  extensive  cavities  and  tuberculous 
'deposits  which  have  not  been  noticed.  The  sup- 
posed shock  from  the  removal  of  alcohol  is  largely 
a  mental  condition  fostered  by  the  fears  of  the 
person.  No  successful  treatment  can  be  carried 
out  while  the  spirits  are  being  used.  ISTo  specific 
drugs  can  overcome  the  effects  of  alcohol  when 
given  with  it. 

Many  combinations  can  be  used  to  produce  a 
disgust  for  spirits,  simply  producing  another  spe- 


48 


DRUG  HABITS  AND  THEIR  TREATMENT. 


cies  of  intoxication  which  is  followed  by  nausea 
and  discomfort.  Opinm  and  many  of  the  narcotics 
will  effectually  control  the  drink  craze  by  render- 
ing the  patient  comfortable  and  indifferent  to  all 
other  means  of  relief.  The  desire  for  a  more 
perfect  state  of  feeling  and  removal  of  physical 
and  psychical  pain  is  controlled  by  these  drugs, 
and  alcohol  is  abandoned. 

The  modern  quack  treatment  is  very  largely  a 
recognition  of  this  principle  of  substitution,  giving 
drugs  and  using  measures  which  chemically  and 
physiologically  remove  the  desire  for  spirits.  This 
is  not  curative  in  any  sense;  it  is  simply  drug 
restraint,  and  masking  of  symptoms  which  break 
out  with  greater  force  Avhen  the  restraint  is  re- 
moved. 

The  most  important  treatment  is  a  change  of 
surroundings  and  conditions  of  living.  This  en- 
ables the  patient  to  adapt  himself  to  new  states 
with  greater  ease.  Going  away  to  a  sanitarium 
or  asylum  with  a  distinct  purpose  and  having 
changed  surroundings,  diet,  and  methods  of  liv- 
ing, prepares  the  way  for  the  removal  of  spirits 
and  restoration.  This  cannot  be  done  at  home  ex- 
cept in  special  instances  where  the  conditions  and 
mental  occupation  can  be  concentrated  along  new 
lines  of  life  and  living. 

The  first  consideration  is  the  withdrawal  of 
alcohol  and  an  effort  to  eliminate  its  effects  upon 


DIPSOMANIA.  49 

the  system.  There  is  always  associated  with  this, 
states  of  exhaustion  and  irritation  which  call  for 
appropriate  remedies. 

If  the  case  is  a  periodical  drinker,  the  drink 
attack  will  require  special  treatment.  This  can 
often  he  overcome  by  saturated  infusions  of 
quassia  hark  in  doses  of  two  ounces  given  every 
one  or  two  hours  until  the  drink  impulse  sub- 
sides. Then  free  evacuation  of  the  bowels  by  sul- 
phate of  magnesia  or  any  other  salt  which  is  most 
convenient,  and  a  warm  bath.  Following  this, 
rest  in  bed  with  hot  nutrients,  of  which  milk  is 
the  most  valuable. 

On  the  return  of  the  paroxysm,  the  same  treat- 
ment with  the  addition  of  fifty  grains  of  bromide 
of  sodium  will  generally  suffice.  The  paroxysm 
subsiding,  a  period  of  tonic  treatment  must  follow. 
The  tonics  to  be  used  here  will  vary  largely  with 
the  patient.  Usually  some  form  of  arsenic  given 
continuously  for  a  long  time  is  the  best  and  most 
effectual  remedy. 

If  the  paroxysm  returns  at  stated  intervals  its 
approach  can  be  anticipated  and  often  prevented 
by  large  doses  of  nitrate  of  strychnia  given  a  short 
time  before  its  return  or  on  the  first  intimation  of 
this  appearance.  This  remedy  can  be  given  alone 
or  combined  with  phosphoric  acid. 

If  the  drink  period  is  uncertain  in  duration  and 
liable  to  return  at  unexpected  times,  great  care 


50  DRUG   HABITS   AND   THEIR   TREATMENT. 

should  be  given  to  the  diet  and  regularity  of  living. 
Turkish  baths  at  intervals,  followed  by  prolonged 
rest,  are  very  useful. 

On  the  advent  of  the  states  of  excitement  which 
have  preceded  the  drink  craze  some  mild  nar- 
cotics, such  as  valerian,  asafetida,  hops,  and  others 
of  this  class,  are  very  useful. 

If  there  is  a  malarious  history,  some  form  of 
cinchona  or  quinine  may  be  given  until  the  physi- 
ological effects  are  noted.  Sometimes  quinine  can 
be  given  for  a  long  time  with  excellent  effects,  and 
without  its  poison  action. 

Where  there  is  a  history  of  any  specific  trouble, 
arsenic  and  potassium  iodid  are  the  chief  rem- 
edies, which  may  be  supplemented  by  mercury 
according  to  the  conditions  present.  It  is  always 
safe  to  give  mercury.  The  iodid  may  be  given  in 
tonic  doses  for  a  long  time. 

Bitter  barks  and  iron  preparations,  while  very 
useful  and  valuable  medicines,  cannot  be  given  for 
any  length  of  time  with  advantage.  The  usual 
effects  of  these  drugs  are  to  stimulate  the  appetite, 
producing  indigestion  and  nutrient  disturbances 
which  seriously  diminish  the  results  sought  for. 

The  next  most  important  remedy  is  baths. 
These  will  depend  very  largely  on  the  patient, 
his  habits,  and  present  condition.  If  a  gourmand 
suffering  from  dyspepsia,  a  Turkish  bath  and  mas- 
sage may  be  given  with  profit  every  day  for  the 


DIPSOMANIA.  51 

first  two  weeks,  then  lengthened  out  to  one  every 
two  or  three  days.  If  such  a  bath  is  not  con- 
venient, an  ordinary  tub  bath  with  warm  water 
and  free  rubbing  will  take  the  place.  Under  all 
circumstances  massage  and  sponging  should  be 
given  every  day,  if  nothing  more  can  be  had.  Sa- 
line cathartics,  both  carbonated  and  otherwise,  are 
very  valuable,  particularly  for  their  action  on  the 
skin  and  kidneys. 

The  use  of  narcotics  will  vary  largely  with  the 
conditions  present.  Opium  is  a  very  effectual 
remedy  but  dangerous  in  the  possibility  of  creat- 
ing an  addiction.  Under  all  circumstances  the 
patient  should  not  know  the  name  or  character 
of  the  drugs  given.  If  narcotics  are  used  they 
should  be  given  early  in  the  evening  so  that  their 
effects  may  encourage  natural  sleep  and  thus  ob- 
viate the  necessity  of  large  doses.  Experience 
shows  th^t  one  grain  of  opium  in  the  forenoon  is 
required  to  produce  steadiness  of  the  nervous 
system,  whereas  at  night  one-half  a  grain  will 
produce  more  prominent  effects. 

Many  cases  have  delusions  of  drug-reliance,  be- 
lieving they  cannot  recover  unless  using  drugs 
very  often.  This  class  must  be  treated  with 
placebos  and  exact  methods  of  administration  and 
strict  accountability  as  to  time  and  place  when 
taken.  This  serves  to  impress  the  mental  value^ 
of  the  drug,  which  is  always  essential. 


52  DRUG   HABITS   AND   THEIR   TREATMENT. 

Patients  undergoing  treatment  should  be  en- 
couraged to  rest  as  much  as  possible  in  bed  or 
reclining  on  a  cot  or  chair.  The  system  requires 
continuous  rest  and  quietness.  This  can  best  be 
secured  by  having  a  fixed  time  each  day  to  go  to 
their  rooms  to  rest.  Baths  can  be  taken  at  night 
with  the  best  results.  In  the  morning  they  are 
also  good  but  should  rarely  be  given  in  the  middle 
of  the  day. 

It  is  not  helpful  to  discuss  symj)toms  or  talk 
with  the  patient  to  any  length  about  his  drink 
experience.  There  is  always  a  tendency,  which  is 
morbid,  to  revert  to  these  scenes  and  to  recall 
the  pleasurable  and  exciting  conditio]is  which  were 
present.  They  should  be  taught  to  forget  these 
states  and  to  regard  them  with  disgust  and  regret, 
and  all  recurrence  to  them  should  be  associated 
with  more  positive  declarations  never  to  repeat  or 
to  live  them  over  again. 

One  effect  of  apomorphia,  ipecac,  antimony,  and 
other  emetics  by  producing  intense  nausea,  is  to 
break  up  the  recollection  of  the  past  and  to  impress 
the  memory  of  spirits  with  disgust.  This  is  very 
efEectual  in  some  cases,  and  often  can  be  applied 
with  good  effect.  Thus,  in  one  case,  a  man  who 
had  abstained,  constantly  recurred  to  the  pleasur- 
able incidents  of  his  drink  period,  and  while  as- 
serting that  he  would  never  drink  again,  retained 
the  most  pleasing  recollections  of  the  effects  of 


DIPSOMANIA.  53 

alcohol.  He  was  persuaded  to  drink  again;  given 
apomorpliia^  which  was  followed  by  intense  nausea 
and  vomiting  with  profound  relaxation;  the  result 
of  which  was  the  entire  disappearance  of  all  pleas- 
ing thoughts  of  the  action  of  spirits.  This  was 
followed  by  the  insistence  of  the  statement  that 
he  could  not  drink  again.  Later  another  experi- 
ment was  tried  to  prove  it  with  the  same  result. 
The  idea  of  inability  to  drink  became  fixed  from 
this  point,  and  he  remained  temperate  many  years 
to  his  death.  This  treatment  is  not  of  general 
application,  and  is  full  of  danger. 

The  revulsive  effects  of  an  emetic  not  unfre- 
quently  produce  a  shock  to  the  nervous  system, 
and  may  be  the  starting  point  for  very  serious 
diseases.  The  use  of  alcohol  and  the  conditions 
of  debility  which  preceded  it  may  have  formed 
unknown  states  of  disease  and  degeneration  which 
may  easily  be  excited  and  concentrated  into  some 
organized  form  by  the  revulsive  effects  of  emetics. 
Some  of  the  disastrous  consequences  following  the 
quack  methods  used  indiscriminately  are  no  doubt 
due  to  this  cause. 

In  the  history  of  100  cases  which  had  taken 
the  Keeley  and  other  methods  of  cure,  10  died 
from  general  paresis,  21  from  imbecility  and  de- 
mentia, 30  died  from  acute  pneumonia,  and  the 
remainder  died  from  various  diseases  associated 
with  palsy,  mania  and  profound  exhaustion.     It 


54  DRUG   HABITS   AND   THEIR   TREATMENT. 

would  be  dangerous  to  give  emetic  remedies  to  one 
suffering  from  a  fatty  heart  or  atheromatous  ar- 
teries or  to  persons  suffering  from  prolonged  dys- 
pepsia and  nutrient  disturbances. 

Combinations  of  strychnia  given  indiscrim- 
inately are  also  of  danger.  The  stimulant  action 
in  some  cases  is  so  pronounced  as  to  cause  irrita- 
tion with  extreme  exhaustion.  The  danger  comes 
largely  from  the  fact  that  the  actual  condition 
present  is  unknown,  and  the  possibility  of  increas- 
ing some  trouble  is  certain  in  many  cases. 

That  strychnin  has  a  specific  effect  other  than 
in  a  general  way  is  by  no  means  certain.  If  used 
in  mild  cases  of  the  drug  habit  which  have  come 
from  ordinary  exhaustion  and  neglect  of  the  hy- 
gienic rules  of  living,  its  effects  are  very  marked, 
but  in  other  cases  where  the  causes  are  farther 
back,  and  the  drinking  is  only  a  symptom,  its 
value  is  questionable.  In  periodic  and  convulsive 
cases  it  is  sometimes  a  marked  sedative  and  takes 
the  place  of  spirits  most  effectually  but  its  effects 
seem  to  be  lost  after  two  or  three  weeks,  and  its 
value  depends  upon  its  alternate  use. 

The  treatment  of  the  continuous  drinker  in- 
volves the  same  principles,  only  a  different  appli- 
cation of  them.  In  one  who  is  accustomed  to 
use  spirits  daily  some  substitute  is  required  after 
their  removal.  This  may  be  found  in  strychnin, 
phosphate  of  sodium,  quinin,  and  preparations  of 


DIPSOMANIA.  55 

cincliona  bark.  To  these  may  be  added  some  of 
the  milder  narcotics,  of  which  the  bromids  and 
the  vegetable  narcotics  are  the  most  valuable. 
Occasionally  opium  or  its  alkaloids  will  be  found 
valuable  for  sleep  at  night.  Care  should  be  taken 
not  to  continue  them  long  or  to  allow  the  patient 
to  know  what  he  is  taking.  Some  of  the  coal-tar 
derivatives  can  be  used  with  good  effect,  and 
these  with  vigorous  massage  and  bathing  com- 
prise the  most  practical  measures. 

Tinctures  should  be  avoided  because  of  the  alco- 
hol which  they  contain.  Very  slight  quantities  of 
alcohol,  although  concealed  by  bitter  drugs,  are 
often  very  effectual  substitutes  for  spirits,  hence 
specific  remedies  for  the  cure  are  composed  of 
alcohol.  While  using  these  specifics,  they  leave  no 
desire  for  spirits;  in  reality  they  are  taking  spirits, 
only  concealed.  It  is  safe  to  say  that  all  the 
remedies  on  the  market  promising  to  cure  such 
cases  in  a  brief  time  •  contain  either  alcohol  or 
opium.  Many  of  the  most  popular  tonics  of  the 
day,  so  highly  praised  and  largely  sold,  depend 
for  their  virtue  on  one  or  both  of  these  drugs.    , 

It  is  possible  to  treat  these  cases  at  home  in 
the  early  stages  but  only  with  the  fullest  co-oper- 
ation of  the  patient  and  his  most  earnest  effort  to 
follow  out  the  directions  of  his  physician.  Later, 
after  a  long  period  of  addiction,  it  is  doubtful  if 


56  DRUG    HABITS    AND    THEIR    TREATMENT. 

any  good  results- will  follow  except  from  a  total 
change  of  surroundings  and  conditions  of  living. 
Many  patients  need  coercion  at  first  and  alDsolute 
restraint,  making  it  impossible  to  do  otherwise 
than  to  follow  the  dictum  of  the  physician.  This 
can  he  done  in  asylums  by  actual  force  in  locked 
rooms  or  in  private  homes  with  the  services  of  a 
skilled  attendant.  In  all  cases  there  should  he  a 
distinct,  clear  recognition  of  the  objects  to  be 
sought  and  the  condition  present.  To  coerce  and 
confine  a  periodic  inebriate  during  the  free  inter- 
val of  his  drinking  paroxysm  is  a  mistake  and 
increases  the  sources  of  irritation.  When  the 
attack  comes  on  it  is  a  tonic  and  of  value. 

In  the  constant  drinker  alternate  confinement 
and  liberty  is  most  helpful.  The  effort  should  be 
to  constantly  appeal  to  the  will  to  make  an  effort 
to  avoid  dangers  and  put  some  restraint  upon  him- 
self, and  at  the  same  time  to  diminish  all  tempta- 
tion as  far  as  possible.  To  give  a  patient  a  nar- 
cotic which  will  restrain  his  drink  impulses,  and 
then  give  him  liberty  and  urge  him  to  show  his 
sitrength  is  not  a  safe  or  commendable  plan  to 
inspire  confidence  and  rouse  up  a  feeling  of  hope- 
fulness that  he  can  succeed.  The  question  of 
restraint  and  liberty  is  like  other  problems  in 
medicine,  to  be  applied  according  to  the  condition 
of  the  patient.    To  give  equal  liberty  to  all  or  to 


DIPSOMANIA.  57 

keep  all  under  strict  surveillance  are  two  extremes 
whicli  are  not  followed  by  good  results. 

In  a  large  institution  where  personal  discrim- 
ination cannot  he  easily  made,  certain  general 
rules  can  be  applied  requiring  of  each  one  strict 
obedience  to  certain  regulations  which  are  bene- 
ficial to  all.  In  the  treatment,  all  methods  of  the 
adminstration  of  medicines,  with  diets,  and  habits 
of  military  exactness  should  be  required;  all  irreg- 
ularities should  be  avoided. 

In  private  treatment  the  same  is  essential. 
Medicines  should  be  given  at  the  exact  moment 
every  day.  Exercise  and  baths  at  the  exact  time. 
This  creates  obligation^  and  is  stimulating  to  the 
mind. 

It  is  clearly  impossible  to  expect  any  results 
from  two  or  four  weeks^  treatment  by  any  con- 
ceivable method  or  plan.  The  degenerations  and 
injuries  following  and  associated  with  the  use  of 
spirits  cannot  be  repaired  in  that  time.  No  treat- 
ment should  be  for  less  than  from  six  months  to 
a  year.  Patients  do  not  need  to  remain  in  an 
asylum  during  this  time  but  should  have  the  con- 
trol and  care  of  the  medical  attendant. 

A  certain  number  of  periodic  drinkers  are  able 
to  work  during  the  free,  sober  interval,  and  on 
the  return  of  the  paroxysm  should  go  under  treat- 
ment in  an  asylum  or  with  the  family  physician. 


58  DRUG   HABITS   AND   THEIR   TREATMENT. 

Others  after  a  few  months'  residence  in  an  asy- 
lum go  under  the  care  of  the  family  physician  at 
home  or  in  some  favorable  conditions  in  the  coun- 
try.    These  cases  often  do  well. 

PEOGNOSIS. 

The  prognosis  of  these  cases  is  generally  favor- 
able. A  large  number  .are  restored;  some  of  them 
permanently,  as  experience  of  years  proves.  Oth- 
ers relapse  when  exposed  to  temptation  and  are 
worn  out  by  exliaustion  and  strains.  The  perma- 
nent cure  of  these  cases  no  doubt  depends  on 
some  physiological  change  in  the  brain  and  ner- 
vous system,  which  may  come  on  spontaneously 
or  be  cultivated  and  brought  about  by  exact  con- 
ditions of  hygienic  living  with  medical  care  and 
training. 

All  cases  can  be  benefited  by  asylum  treatment 
and  the  treatment  by  specialists  along  lines  of 
exact  medication, but  the  permanency  of  the  restor- 
ation depends  on  many  complex  and  largely  un- 
known factors-.  A  great  deal  can  be  done  in  the 
early  stages  in  personal  private  treatment  by  the 
use  of  tonics  and  saline  drugs  and  other  means 
adapted  to  the  peculiarities  of  the  case.  More 
can  be  accomplished  in  special  asylums  with  spe- 
cial surroimdings  and  appliances,  where  brain  and 
nerve    rest    and   mental    and    physical    training 


DIPSOMANIA.  59 

towards  the  ideal  standard  of  health  may  be  car- 
ried on. 

Public  asylums  to  support  and  to  care  for  the 
large  class  of  chronic  cases  are  a  necessity  which 
will  be  practically  recognized  in  the  very  near 
future. 

A  large  proportion  of  these  cases  could  be  made 
self-sustaining  in  workhouse  hospitals  in  the  coun- 
try, and  would  be  able  to  do  a  good  work  under 
the  espionage  and  care  of  others.  Some  of  this 
class  would  be  permanently  restored  and  go  back 
to  active  life.  Others  would  need  hospital  care  all 
their  life.  All  these  cases  require  medical  treat- 
ment, not  so  much  drugs  or  specific  plans  of  treat- 
ment but  the  scientific  adaptation  of  means  to 
control  and  direct  their  disordered  impulses. 

The  private  treatment  of  these  cases  at  home  in 
the  early  stages  is  thoroughly  practical,  and  very 
often  successful  as  in  any  other  disease.  The 
early  recognition  of  the  drink  impulse  as  a  symp- 
tom as  well  as  a  cause  of  disease  will  suggest  the 
means  and  measures  for  its  practical  treatment. 
When  this  condition  is  recognized  and  acted  upon 
there  will  be  fewer  chronic  cases  and  prevention 
will  take  the  place  of  curative  treatment. 

It  may  be  safely  said  that  all  use  of  spirits  to 
states  of  intoxication  or  continuously  to  stupor 
indicates  disease  and  diseased  conditions  for  which 


60  DRUG  HABITS   AND   THEIR   TREATMENT. 

medical  measures  are  demanded.  The  patient's 
judgment  of  himself  is  wortliless.  His  conduct 
should  govern  the  measures  used.  The  failure  of 
legal  and  moral  methods  point  out  the  necessity 
for  a  new  medical  study  and  application  for  both 
prevention  and  cure. 


OPIUM   INEBRIETY.  61 


CHAPTER  m. 
OPIUM  INEBRIETY. 

Witliin  a  comparatively  recent  period  the  use  of 
opium  and  its  alkaloids  come  into  great  promi- 
nence. There  is  now  a  well  ascertained  disease 
called  "opium  inebriety"  which  has  an  origin, 
development  and  termination  distinctly  defined. 
There  are  many  reasons  for  believing  that  this  dis- 
ease is  rapidly  increasing,  especially  in  large  cities 
and  in  circles  where  there  is  great  mental  activity. 
This  is  confirmed  by  the  quantity  of  opium  and 
morphin  called  for  beyond  the  legitimate  wants 
of  medicine.  Careful  estimates  indicate  that  fully 
fifty  per  cent  of  the  morphin  and  opium  is  con- 
sumed in  some  unknown  way.  This  will  be  un- 
derstood when  it  is  known  that  a  large  number 
of  such  cases  use  opium  secretly. 

Comparative  estimates  make  the  number  of 
opium  cases  in  this  country  to  be  over  a  hundred 
thousand.  While  it  is  very  difficult  to  determine 
the  exact  number,  there  can  be  no  doubt  that  this 
is  not  an  exaggerated  statement.  Many  of  these 
eases  die  from  other  diseases,  and  the  fact  of 
opium-taking  is  only  discovered  after  death.  Up 
to  the  present  time  very  few  studies  of  these  cases 
have  appeared. 


62  DRUG   HABITS   AND    THEIR   TREATMENT. 

Usually  the  symptoms  have  all  dated  from  some 
definite  point  after  the  opium  addiction  began,  and 
the  history  of  the  case  from  this  point  is  more 
or  less  obscure  until  chronic  stages  appear.  Hence 
great  uncertainty  and  doubt  exists  concerning  the 
exact  condition  and  pathology  of  such  cases. 

A  careful  clinical  study  and  grouping  of  the 
history  of  many  opium  cases  points  out  a  neurotic 
diathesis  or  condition  of  brain  and  nerve  defect 
which  predisposes  to  the  development  of  this  dis- 
ease. There  is  an  opium  diathesis  or  special  in- 
herited tendency  to  use  opium  or  other  narcotics. 
Such  persons  exhibit  an  unstable  brain  condition 
which  calls  for  relief  from  every  condition  of  de- 
bility and  fatigue.  If  opium  is  given^^the  effects 
are  so  fascinating  that  its  use  is  ever  after  in- 
dulged in. 

This  particular  tendency  may  be  latent  and  may 
depend  on  certain  conditions  of  life  and  surround- 
ings or  the  application  of  some  peculiar  exciting 
causes.  The  opium-user  has  often  this  neurotic 
element  in  his  history.  His  ancestors  may  have 
suffered  from  severe  nerve  injuries,  c£ll  starvation, 
faulty  nutrition,  auto-intoxications,  brain  strains, 
with  excessive  drains  or  nerve  force.  The  children 
following  will  have  decided  nerve  defects  which 
may  find  in  opium  the  most  pleasing  nepenthe, 
and  its  use  will  ever  afterward  be  followed.  Kext 
to  the  inherited  diathesis  comes  the  acquired  de- 


OPIUM   INEBRIETY.  63 

fects.  These  may  begin  with  diseases  in  early 
childliood  which  leave  retarded  growth  and  per- 
verted nerve  activities.  States  of  defective  nutri- 
tion and  bad  surroundings  leave  similar  defects. 
Following  these  are  a  great  variety  of  complex 
strains  and  drains  which  leave  the  nervous  system 
defective.  States  of  brain  and  nerve  instability 
with  low  vitality  and  tendency  to  exhaustion  and 
hypersensitiveness  to  pain  from  every  degree  of 
disturbance  with  feeble  powers  of  restoration^  are 
all  characteristic  early  symptoms  of  the  opium 
disease. 

The  narcotism  from  opium  is  very  grateful  to 
most  of  these  neurotics,  and  is  tolerated  in  large 
doses  from  the  beginning.  A  dose  of  morphin, 
calming  the  excitement  and  giving  complete  rest, 
is  a  physiological  revelation  which  profoundly  im- 
presses the  organism.  This  hypersensitiveness  to 
pain  and  delusional  impulse  to  avoid  it  at  all 
hazards  is  the  basis  of  all  opium  disease.  After 
opium  has  been  used  a  few  times  this  increases 
rapidly,  particularly  to  avoid  pain,  and  a  species 
of  mania  follows  possessing  the  mind  thoroughly 
and  demanding  relief  from  all  discomfort.  Along 
with  this  comes  the  delusion  that  this  is  only  a 
temporary  condition  which  can  be  stopped  at  will 
at  any  time.  This  continues  to  the  very  last,  not- 
withstanding all  the  failures  and  repeated  efforts 
to  abstain  from  opium  the  idea  is  dominant  that  it 


64 


DRUG    HABITS    AND   THEIR    TREATMENT. 


can  be  done  by  the  will  of  the  person.  This  morbid 
impulse  for  opium  is  a  veritable  mania,  and  soon 
becomes  a  symptom  of  some  brain  degeneration 
which  increases,  involving  one  by  one  the  higher 
brain  centers  until  imbecility  and  idiocy  is  reached. 

The  opium-taker  is  on  the  road  to  imbecility. 
Low  states  of  delusional  mania  may  appear,  but 
the  gradual  weakening  and  profound  dissolution 
of  all  the  liigher  functions  is  inevitable.  In  some 
cases  the  march  is  rapid  and  progressive  along  well- 
defined  tracts;  in  others  it  is  slow,  with  halts 
and  intervals  and  apparent  retrograde  movement. 
Periods  of  abstinence  may  occiir  followed  by  re- 
lapses and  more  precipitate  decline.  Delusions  of 
strength  and  of  power  of  concealment  and  cunning 
to  deceive  and  cover  up  liis  real  condition  are  al- 
ways prominent.  Consciousness  of  right  and  wrong 
and  veracity  in  matters  pertaining  to  himself  dis- 
appear early,  and  the  only  motive  which  remains 
with  any  persistency  is  to  procure  opium  and  to 
avoid  pain.  Many  of  these  cases  are  very  com- 
plex. The  degeneration  often  seems  to  be  local 
while  other  faculties  remain  the  same. 

Some  of  these  cases  exhibit  a  degree  of  unim- 
paired vigor  along  certain  accustomed  lines,  while 
others  show  profound  deterioration.  Many  of 
these  cases  show  hypersensitiveness  to  their  own 
condition,  but  seem  to  be  impotent  to  change  it. 
They  are  in  a  continual  conflict  with  the  desire  to 


DIPSOMANIA  65 

abandon  the  drug,  and  failures  to  take  the  first 
step,  particularly  where  it  is  followed  with  the 
least  suffering.  They  show  great  anxiety  to  re- 
cover, but  will  not  make  any  effort.  These  defects 
of  will  are  all  significant  of  psychical  change  and 
degeneration.  Dr.  Kerr  calls  these  cases  narco- 
maniacs in  whom  the  morbid  impulse  for  relief 
is  ever  present.  These  cases  are  always  serious, 
and  are  always  associated  with  psychopathic  condi- 
tions and  states  of  life  and  living  which  require  the 
clearest  wisdom  to  overcome. 

In  the  treatment  the  central  fact  of  removing 
the  drug  is  of  small  importance  compared  with 
the  removal  of  the  causes  and  the  conditions  which 
have  favored  this  impulse.  As  in  the  alcoholic, 
the  removal  of  the  active,  exciting  cause,  spirits, 
is  only  a  small  part  of  the  real  treatment.  The 
conditions  which  preceded  the  use  of  opium  must 
be  studied,  and  the  defects  which  have  followed 
from  its  use  must  be  ascertained.  Then  the  ques- 
tion of  treatment  can  be  determined. 

In  the  removal  of  the  drug  many  clinicians  have 
laid  down  elaborate  plans  and  defended  them  with 
earnestness  on  the  supposition  that  they  were 
finally  curative.  This  is  not  sustained  by  more 
careful  studies.  Some  of  the  general  facts  which 
must  be  recognized  may  be  grouped  as  follows: 
Where  an  opium  diathesis  or  predisposition  to  ob- 
tain relief  from  all  states  of  pain  and  exhaustion 


66  DRUG  HABITS  AND   THEIR   TREATMENT. 

has  come  down  from  the  past  generation,  the  with- 
drawal of  opium  should  be  gradual,  and  the  treat- 
ment should  have  reference  to  constitutional 
changes.  In  such  cases  the  surroundings  should 
be  regulated  with  care  and  exactness.  The  patient 
should  commence  a  military  regime  of  life  and  liv- 
ing and  the  opium  should  be  withdrawn,  covering 
a  period  of  many  days  and  weeks,  depending  upon 
the  sensitiveness  of  the  person.  With  this  should 
be  associated  careful  diet,  regular  baths,  and  exer- 
cise, and  mental  diversion.  When  the  amount  has 
been  reduced  to  a  minimum  other  mild  narcotics 
may  be  given  and  the  opium  withdrawn.  Of  these 
narcotics,  a  great  variety  may  be  chosen  from — 
such  as  valerian,  hyoscyamus,  lupulin,  bull-nettle, 
and  others  of  this  class,  using  the  one  which  seems 
to  be  the  most  positive  in  its  effects.  Baths  should 
be  increased  and  massage  should  be  taken  every 
day.  Often  hot  liquid  foods,  as  hot  milk,  beef 
extracts,  and  some  malted  food  preparations,  can 
be  used  with  advantage.  Mineral  waters,  particu- 
larly soda  waters,  are  of  great  advantage  to  neu- 
tralize the  acidity  of  the  stomach. 

The  withdrawal  symptoms,  of  which  diarrhea 
is  the  most  prominent,  can  be  easily  overcome  by 
baths,  slight  astringents  and  rest  on  the  back.  Hot 
fomentations  over  the  bowels  give  local  relief  from 
the  tenesmus.  The  gastric  irritation  is  most  quick- 
ly relieved  by  soda  preparations,  and  long  periods 


DIPSOMANIA.  67 

of  rest.  The  withdrawal  symptoms  of  exhaustion, 
irritation  and  general  relaxation  are  nsnally  of 
short  duration,  and  not  at  all  severe  in  these  cases 
where  the  opium  has  been  gradually  withdrawn. 
After  the  acuteness  of  the  symptoms  has  subsided 
a  tonic  of  strychnia  is  very  serviceable.  Beginning 
with  one-thirtieth  of  a  grain  four  times  a  day  and 
increasing  this  up  to  every  two  or  three  hours  if  it 
can  be  borne  by  the  patient  without  toxic  symp- 
toms, then  decrease  the  frequency  of  the  dose  to 
two  or  three  times  a  day  for  several  weeks.  In 
addition  to  this,  preparations  of  cinchona  bark  and 
iron  can  be  used  with  advantage.  Phosphate  of 
sodium  is  also  a  favorite  remedy  given  in  ten-grain 
doses  four  times  a  day  for  several  weeks. 

The  after  treatment  will  vary  largely  with  the 
person  and  his  surroundings,  but  should  always  in- 
clude baths,  carefully  selected  nutritious  food  com- 
bined with  exercise  and  all  possible  conditions 
favoring  nerve  and  brain  rest.  In  cases  where 
opium-taking  has  come  from  brain  strains  and 
drains  in  a  previously  healthy  person,  the  treat- 
ment will  vary.  The  opium  should  be  removed 
rapidly,  and  other  drugs  substituted  at  once.  The 
narcotism  from  opium  must  be  broken  up  and  its 
peculiarly  fascinating  effects  overcome. 

Dr.  Parrish  found  the  best  results  to  follow 
from  the  use  of  ipecac  in  those  cases  where  the 
person  had  taken  opium  for  some  form  of  pain 


68  DRUG   HABITS   AND    THEIR   TREATMENT. 

the  result  of  injury  or  nutritional  disturbance. 
He  was  accustomed  to  reduce  the  opium  rapidly  and 
to  associate  its  use  witi.  nauseating  doses  of  ipecac. 
The  revulsive  action  and  relaxation  which  followed 
soon  broke  up  the  fascination  from  the  narcotism 
of  opium.  This  was  followed  by  large  doses  of 
quinin  and  tincture  of  lupulin  or  other  mild  nar- 
cotics. The  withdrawal  symptoms  were  very  great- 
ly lessened  by  the  mental  disgust  and  dread  of 
opium.  Baths  were  used  daily  and  soda  prepara- 
tions in  the  form  of  carbonated  waters  were  given. 

Dr.  Mattison  treated  all  these  cases,  from  what- 
ever cause,  with  bromide  of  sodium,  giving  in- 
creasing doses  and  withdrawing  the  opium  within 
a  day  or  two.  Bromism  followed  in  these  cases 
and  was  considered  of  less  importance  and  more 
easily  overcome  than  the  relaxation  from  opium 
withdrawal.  In  these  cases  pain  would  be  absent 
and  the  patient  would  recover  after  an  uncertain 
period  of  stupor  and  somnolence  suffering  only 
from  profound  mental  and  physical  exhaustion. 
This  plan  of  treatment  has  not  been  found  val- 
uable only  in  exceptional  cases. 

Innumerable  plans  have  been  devised  and  car- 
ried out,  and  a  great  variety  of  drugs  have  been 
urged  as  specifics,  but  none  of  them  have  stood  the 
test  of  experience  as  applicable  to  all  cases. 

In  my  experience  the  condition  of  the  patient 
and  his  inherited  psychosis  determines  the  course 


DIPSOMANIA. 


of  treatment.  The  question  most  commonly  dis- 
cussed by  both  physician  and  patient  is  the  sudden 
or  gradual  withdrawal  of  the  opium.  To  the 
patient  the  sudden  withdrawal  presents  horrors 
which  he  wishes  to  avoid.  To  the  physician  the 
gradual  withdrawal  means  complications  and  com- 
plexities of  methods  and  plans  which  are  to  be 
avoided  if  possible.  The  lengthening  out  of  the 
withdrawal  symptoms  to  weeks,  and  even  months, 
is  not  followed  by  good  results.  Each  case  should 
be  a  law  to  itself.  For  example,  a  person  coming 
from  a  degenerate  family,  who  has  had  an  early 
period  of  alcoholic  addiction,  followed  by  the  use 
of  opium,  has  still  farther  broken  up  the  nutrition 
of  the  body  and  perverted  all  healthy  mental  and 
physical  functional  activities,  and  is  now  taking 
large  quantities  of  opium  and  alternating  it  with 
spirits  at  irregular  intervals,  requires  a  special  and 
peculiar  treatment. 

First,  his  surroundings  and  conditions  of  living 
must  be  methodical  and  exact.  Spirits  must  be 
abandoned  at  once,  and  the  opium  withdrawn  grad- 
ually for  the  first  week,  dropping  down  to  a  mini- 
mum dose  and  keeping  him  on  this  amount  until 
his  system  becomes  accustomed  to  this  change. 
Sometimes  this  requires  two  or  three  weeks,  giv- 
ing uniform  doses  every  day  without  change ;  then 
a  diminution  for  several  days  and  another  long 
halt  in  which  the  same  amount  is  given  regularly. 


70  DRUG    HABITS    AND    THEIR    TREATMENT. 

When  the  amount  has  been  reduced  to  a  grain  of 
opimn  or  a  quarter  of  a  grain  of  morphia  in  twen- 
ty-four hours  substitution  may  begin.  Large  doses 
of  bromide  of  sodium  may  be  given  eyerj  two  hours 
until  two  hundred  grains  are  taken,  then  stop.  If 
this  is  not  well  borne,  some  vegetable  narcotic 
may  be  given  in  large  doses.  If  the  withdrawal 
sj-^mptoms  are  prominent,  tincture  of  opium  may 
be  substituted,  not  to  exceed  one  or  two  doses. 
The  patient  in  the  meantime  must  be  kept  in  a 
reclining  position  and  given  hot  baths  and  mas- 
sage. Strychnia  may  be  given  in  large  doses  either 
by  the  mouth  or  hj'podermically. 

The  after-treatment  will  consist  of  tonics,  sa- 
lines, baths  and  long-continued  rest.  Such  per- 
sons should  continue  treatment  for  months,  and 
possibly  5"ears  in  changed  surroundings  and  differ- 
ent conditions  of  living.  Where  the  needle  has 
been  used,  a  new  complication  arises,  and  to  over- 
come this  the  ingenuity  of  the  physician  will  be 
taxed  seriously.  Sometimes  a  continuation  of  the 
needle  with  water  injections  serves  a  very  good 
purpose,  and  permits  the  abandonment  of  the  drug 
with  very  slight  after  symptoms.  In  other  cases 
the  substitution  of  apormorphia,  with  its  peculiar 
depressing  and  nauseating  effect,  soon  breaks  up 
the  needle  addiction.  In  a  second  example,  where 
the  morphia  addiction  is  uncomplicated  with  spir- 
its, and  seems  to  have  grown  up  from  some  state 


DIPSOMANIA.  71 

of  exhaustion  and  neuralgia  or  disturbance  of  the 
nerve  and  sense  centers^  the  treatment  must  diJffier. 
There  is  often  in  this  a  large  mental  element  which 
must  be  considered  and  treated.  The  patient  must 
not  only  be  in  exact  surroundings  but  mental  di- 
version must  be  provided,  the  mind  must  be  di- 
verted as  far  as  possible,  and  sometimes 
concentrated  on  elaborate  plans  of  treatmeat. 
Placeboes  every  hour,  military  exactness  of  rest 
and  times  of  eating,  massage  and  baths  must  be 
required.  The  morphia  should  be  cut  down  at 
once,  and  if  the  withdrawal  symptoms  are  ^t  all 
severe,  mild  narcotics  may  be  substituted. 

Every  measure  should  appeal  to  the  mind  to 
rouse  up  confidence  and  to  create  new  hope.  Fre- 
quently the  morphia  can  be  withdrawn  in  a  few 
days  and  the  usual  tonics  of  strychnia,  quinin, 
iron  and  arsenic  can  be  given  in  varying  forms, 
associated  with  placeboes  and  mental  medicines. 
The  ingenuity  of  the  physician  will  be  taxed  to 
the  utmost  to  vary  these  drugs  and  keep  the  confi- 
dence of  the  patient.  Oftentimes  exercise  even  up 
to  the  point  of  occupation  is  valuable.  The  diet 
and  digestion  should  be  considered  with  great  care, 
and  no  withdrawal  symptoms  should  be  allowed  to 
progress  very  far,  even  at  the  expense  of  recurring 
again  to  the  drug  for  a  single  dose.  If  the  morphia 
is  taken  by  the  needle,  the  mental  symptoms  can 


73  DRUG   HABITS   AND   THEIR  TREATMENT. 

be  treated  for  a  long  time  with  success.  In  these 
cases  the  appearance  of  unknown  local  disturbances 
which  have  been  masked  by  the  drug  are  to  be 
anticipated  and  treated.  The  success  of  such  a 
case  depends  largely  upon  psychical  treatment,  the 
efficiency  of  nursing  and  the  exactness  of  surround- 
ings. In  a  third  example  where  morphia  has  been 
used  to  lessen  the  pain  of  organic  diseases  or  to 
relieve  the  infirmities  of  age,  the  treatment  should 
also  vary. 

It  will  be  a  disputed  question  whether  the  re- 
moval of  morphia  can  be  practically  and  success- 
fully carried  out  in  cases  of  paresis,  locomotor 
ataxia,  carcinoma  or  organic  diseases  of  the  kid- 
neys and  liver.  If  it  is  found  advisable  to  do 
this,  the  treatment  in  the  removal  of  morphia 
should  be  gradual  and  tentative,  depending  upon 
the  condition  present,  and  the  irritation  which 
seems  to  follow.  Great  care  should  be  used  in 
substitYiting  other  drugs,  particularly  when  their 
addiction  is  likely  to  be  followed  with  more  se- 
rious results.  ITot  unfrequently  the  removal  of 
morphia  is  ver}^  easily  accomplished  in  these  cases. 
The  irritation  and  relaxation  following  may  be 
slight,  but  the  possibility  of  relapse  is  almost  cer- 
tain. Alterative  tonics  should  be  used  from  the 
start,  of  which  mercury  and  arsenic  and  the  various 
forms  of  phosphorous  are  most  excellent.    In  old 


DIPSOMANIA.  73 

age  the  removal  of  morphia  can  be  quickly  accom- 
plished by  substituting  some  of  the  milder  vege- 
table narcotics.  Here  constitutional  treatment 
is  essential,  with  great  attention  to  the  hygienic 
conditions  of  diet  and  surroundings.  These  three 
examples  include  a  large  number  of  opium  and 
morphia  takers. 

Eecently  a  class  of  professional  and  brain  work- 
ers has  come  into  prominence  where  morphia  is 
taken  for  its  stimulant  effect  as  well  as  to  quiet 
nerve  and  brain  fatigue.  These  cases  should  be 
treated  heroically;  the  opium  should  be  removed 
by  the  use  of  substitutes,  and  active  medication 
follow.  States  of  neurasthenia  and  cerebrasthenia 
always  present  should  be  treated  on  general  princi- 
ples. All  such  persons  should  have  asylum  or  sani- 
tarium care  for  months,  followed  by  rest  in  the 
country  for  an  equally  long  time.  Many  of  them 
must  give  up  all  brain  labor  and  abandon  all  oc- 
cupation associated  with  mental  strain.  The  gen- 
eral treatment  is  the  same — baths  for  elimination, 
food  and  tonics  for  building  up,  rest  and  diversion 
for  training  them  out  of  their  old  life  and  living. 
The  opium  disease  is  curable  in  a  large  number  of 
instances,  but  never  by  specific  drugs  or  mechanical 
plans  of  treatment,  and  never  by  simply  withdraw- 
ing the  drug,  no  matter  how  painless  or  perfect. 
The  brain  and  nervous  system  has  suffered  some 


74  DRUG  HABITS   AND   THEIR   TREATMENT. 

profound  shock  and  change  which  cannot  be  over- 
come except  by  long  care  and  medicinal  measures. 


DDIPSOMANIA. 


75 


CHAPTER  IV. 

COCAIN  AND   OTHER   DRUG 
ADDICTIONS. 

The  cocain  addiction  has  been  called  the  third 
great  scourge  of  the  world, — alcohol  and  opium 
addictions  being  the  first  and  second.  The  most 
remarkable  fact  is  that  only  a  small  part  of  the 
cocain  imported  and  used  is  known  to  go  into 
legitimate  channels.  An  inquiry  in  Philadelphia 
showed  that  sixty  per  cent  of  the  cocain  was  sold 
and  used  in  unknown  ways.  It  is  extremely  diffi- 
cult to  know  how  far  its  addiction  has  extended. 
The  frequency  of  the  cases  is  becoming  more  and 
more  apparent,  particularly  in  the  large  centers. 
Usually  the  cocain  taker  has  had  a  previous  experi- 
ence with  morphin  and  spirits,  and  finds  the  cocain 
a  great  improvement  over  the  two.  From  this  drug 
he  gets  mental  exhilaration  and  physical  satisfac- 
tion without  any  of  the  depressions  which  follow 
the  use  of  the  other  drugs.  It  is  noted  that  ema- 
ciation and  rapid  decline  of  both  the  physical  and 
mental  activities  are  very  marked  in  the  opium 
case  which  becomes  a  cocain-taker.  A  pleasing 
state  of  mental  exaltation  and  volubility  follows 
its  use.     The  mind  seems  to  run  on  with  great 


76  DRUG   HABITS   AND    THEIR   TREATMENT. 

rapidity,  the  thoughts  flow  with  confused  medley 
without  point  of  conclusion,  interlaced  and  com- 
bined with  all  sorts  of  ideas,  fears  and  credulities. 
This  mental  condition  seems  to  be  without  con- 
ception of  time  or  present  condition,  passing  from 
all  grades  of  hallucinations  and  delusions  of 
suspicion,  credulity  and  good  humor  to  states  of 
imbecility  and  sleep.  In  some  instances  great 
assertiveness  with  indecisiveness  of  thought  follow 
in  a  confusing  medley. 

The  principal  delusion  characteristic  in  most 
cases  is  that  of  parasitic  infection  principally  of 
insects  crawling  over  the  skin,  marked  by  itching 
and  uncomfortable  feelings.  Delusions  of  perse- 
cution, not  only  to  himself  but  to  others,  often 
rouse  indignation  and  efforts  to  correct  them. 
Oftentimes  it  is  self-accusation,  and  is  followed 
by  crime,  generally  suicide  to  escape  from  his  pur- 
suers. During  all  this  time  there  is  a  reasoning 
mania  with  the  pleasing  imagination  that  invests 
objects  near  and  far  away  with  personal  interests. 
In  some  instances  intense  depression  follows 
alternated  with  transient  exaltation.  His  voice 
and  manner  give  evidence  of  his  mental  condition. 
The  soft,  persuasive  tones,  and  the  smiling,  affable 
appearance  and  supreme  consciousness  of  his  great 
vigor  and  perfect  strength  is  characteristic.  He 
believes  his  condition  is  exaggerated  by  his  friends 
and  that  he  does  not  need  to  make  any  exertion 


COCAIN    AND    OTHER    DRUG   ADDICTIONS.  77 

himself,  that  the  effects  of  the  drag  are  not  dan- 
gerous but  rather  helpful,  enabling  him  to  do  what 
would  be  impossible  to  do  otherwise.  His  personal 
appearance  is  greatly  changed;  anemia,  glassy 
staring  eye;  nervous,  trembling  walk,  which  be- 
comes more  feeble  as  the  effects  of  the  drug  wear 
off.  His  digestion  is  impaired,  and  often  convul- 
sions and  partial  unconsciousness  of  short  dura- 
tion follow.  Attacks  of  sudden  melancholia  may 
end  in  suicide  or  some  violent  act.  The  effect  of 
cocain  on  the  mind  is  remarkable  in  destroying 
the  moral  sense  first.  All  consciousness  of  right 
and  wrong,  of  duty  and  obligation  and  pride  of 
personal  appearance  disappear  earty.  He  may 
seem  physically  to  be  very  little  different  except 
anemia  and  general  nervousness.  Mentally  he 
will  be  optimistic  and  extremely  voluble  but 
morally  he  vnll  be  utterly  depraved,  irresponsible 
and  unreliable  to  the  last  degree.  These  condi- 
tions rapidly  merge  into  imbecilitj',  suicide  or 
acute  mania.  The  delusions  take  on  an  imagina- 
tive character  often  very  interesting  psychologi- 
cally as  indicating  the  dominance  of  certain  brain 
sections  and  functions. 

In  one  case  under  my  care  literary  delusions 
manifest  in  continuous  writing  of  poetry  occupied 
nearly  all  the  time  of  the  patient  while  awake. 
In  another,  plans  of  military  campaigns  were  the 
absorbing  topic   of   liis  thoughts.      In   a   third. 


78  DRUG    HABITS    AND    THEIR   TREATMENT 

schemes  for  breaking  up  the  poverty  of  the  masses 
were  his  constant  dream. 

These  cases  will  vary  largely  according  to  the 
condition  which  has  preceded  the  opium  addiction. 
If  they  have  been  alcoholics,  more  manias  and 
deliriums  will  follow.  If  they  have  been  opium- 
takers,  less  mental  activity  and  more  of  functional 
delusions  will  appear.  If  the)^  have  taken  up 
cocain  for  some  local  condition  and  irritation  and 
have  been  neurasthenics  before  the  addiction,  the 
mental  perversion  will  be  very  prominent.  A 
large  number  of  cases  have  found  the  use  of  cocain 
at  first  medicinal  for  the  relief  of  catarrhal  and 
local  inflammations.  From  this  point  they  have 
continued  it  for  its  general  effects. 

Two  conditions  follow  in  all  these  cases — one, 
that  of  exaltation  of  the  intellectual  faculties — the 
other  lowering  of  the  senses  and  functional  activ- 
it}^  Both  may  occur  together,  but  in  one  the 
senses  and  functional  activities  may  be  more 
seriously  affected  at  first.  In  the  other  the  intel- 
lectual faculties  show  abnormities  from  the  begin- 
ning. 

The  effects  of  cocain-taking  usually  end  in  death 
or  serious  mental  disturbances  within  one  or  two 
years.  Often  the  use  of  cocain  is  abandoned  for 
morphin,  then  taken  up  years  afterward.  The 
prognosis  is  always  grave  when  the  addiction  is 
continued  any  length  of  time.     It  is  not  difficult 


COCAIN    AND    OTHER    DRUG    ADDICTIONS.  79 

to  remove  the  drug  and  secure  temporary  restora- 
tion, but  unless  this  is  followed  by  the  most  radical 
change  of  life  and  living  with  the  avoidance  of 
every  source  of  exhaustion  and  every  possible  peril 
and  danger,  relapse  is  to  be  expected. 

The  general  treatment  must  begin  with  isola- 
tion and  removal  of  all  exciting  causes  in  a  sani- 
tarium or  asylum  where  the  surroundings  are 
military  and  exact.  In  every  case  special  localized 
means  are  essential  to  meet  the  various  conditions 
present.  The  drug  can  be  removed  at  once.  Some- 
times narcotics  may  be  used  for  substitutes  for  a 
day  or  more  but  usually  they  are  of  little  value. 
Sharp  elimination  through  the  skin,  kidneys,  and 
bowels  is  the  first  indication.  The  continuous 
activity  of  the  skin  by  hot  air,  warm  and  medi- 
cated baths,  are  required  daily  for  a  long  time. 
Anemia,  h}^eremia,  and  insomnia,  each  requires 
sjjecial  medication,  of  which  foods  and  tonics  are 
usually  sufficient.  Preparations  of  iron  and  bark 
are  valuable  for  a  short  time.  Arsenic  appears 
to  be  the  best  of  all  the  mineral  tonics,  and  should 
be  given  many  weeks.  Acids  are  also  very  excel- 
lent. The  phosphates  and  preparations  of  soda 
and  magnesia  are  equally  valuable.  Strychnia  does 
not  seem  to  be  well  borne  and  cannot  be  used  in 
some  instances,  nux  vomica  being  preferable,  and 
its  use  may  be  continued  for  a  long  time.  Of 
foods,  meats  should  be  used  sparingly  at  first; 


80  DRUG   HABITS   AND  THEIR  TREATMENT. 

later,  their  use  can  be  increased.  A  diet  of  eggs, 
milk  and  fruit  is  the  best.  The  patient  should 
remain  in  bed  during  the  first  week  of  active  treat- 
ment. Massage  may  be  given  for  an  hour  every 
day  during  this  time.  Later  he  may  be  taken  out 
to  walk  a  few  moments  every  day  in  the  open  air. 
Exercise  and  massage  depend  for  their  value 
largely  upon  the  adaptability  to  the  condition  of 
the  case  at  the  time.  In  a  brain-worker,  less  exer- 
cise is  required  than  in  a  muscle-worker  or  one 
who  is  in  the  open  air  much  of  the  time.  In  an 
over-fed,  plethoric  person,  exercise  is  better  borne 
and  followed  by  greater  relief  than  in  thin,  spare 
persons. 

Often  the  patient  should  remain  in  bed  two  or 
three  weeks,  particularly  where  the  reaction  symp- 
toms are  those  of  depression  and  great  prostration. 
Daily  baths  should  be  continued  for  many  weeks 
together  with  a  rigid  living  and  diet,  which  shoulc. 
be  insisted  upon  for  a  much  longer  period. 

Many  of  these  cases  require  an  entire  change 
of  surroundings  and  removal  of  local  exciting 
causes.  The  tendency  to  drug-taking  should  be 
overcome  by  reliance  on  hygienic  measures  and 
physical  training,  together  with  careful  diet.  The 
restoration  of  the  disordered  mind  is  to  be  expected 
only  from  prolonged  rest  and  diversion  of  all 
functional  activities. 

The  cocain-taker  can  rarely  be  treated  at  home 


COCAIN    AND    OTHER   DRUG   ADDICTIONS.  81 

with  success.  Like  other  cases  of  drug  addiction, 
a  careful  study  must  be  made  of  the  causes,  both 
exciting  and  predisposing,  which  lead  up  to  this 
condition.  To  this  add  a  careful  history  of  the 
present  addiction  and  the  injuries  which  have  re- 
sulted from  the  use  of  the  drug,  then  the  therapeu- 
tic indications  will  be  clear.  Whenever  cocain  is 
used  for  its  medicinal  effects  care  should  be  taken 
to  watch  its  effects  and  to  conceal  its  character 
from  the  patient.  But  few  cases  are  on  record 
Inhere  it  has  been  given  in  surgical  operations  that 
it  was  followed  by  an  addiction.  Most  commonly  it 
is  found  in  catarrhal  remedies,  and  often  is  the 
basis  of  the  successful  proprietary  drug.  It  is 
also  given  by  unprincipled  and  thoughtless  persons 
for  the  relief  of  opium  and  alcohol  addictions, 
with  the  result  of  producing  more  serious  difficul- 
ties than  it  seeks  to  remove. 

It  is  doubtful  if  the  fascination  of  the  drug  is 
ever  fully  dispelled.  The  patient  may  abstain  for 
years  from  its  use  and  from  the  slightest  exciting 
cause  the  impression  of  its  relief  will  come  back 
again.  Sometimes  this  is  overcome  by  the  good 
jud'pnent  of  the  person,  but  where  the  opportunity 
is  present  and  the  judgment  is  weak  it  is  taken 
again  with  readiness.  Some  cases  have  fully  recov- 
ered, but  the  disability  which  follows  its  use  has 
continued  in  varying  degree  the  rest  of  the  life. 


83  DRUG   HABITS   AND    THEIR   TREATMENT. 

CHLOROFOEM 

The  use  of  cliloroform  as  a  drug  addiction  is 
not  common.  Xearly  all  cases  follow  the  use  of 
alcohol  or  opium.  The  delirium  and  insomnia 
from  the  above  drugs  are  relieved  by  the  inhala- 
tion of  chloroform.  Frequently  chloroform  is 
taken  to  break  up  a  drink  craze,  and  later  the 
effects  are  so  pleasant  that  it  is  used  in  the 
place  of  alcohol  or  opium.  In  many  cases  chloro- 
form is  given  for  some  acute  pain  or  distressing 
condition  of  insomnia  or  some  state  of  exhaustion 
and  irritation.  The  relief  is  so  prompt  and  com- 
plete that  it  is  repeated.  The  odor  is  also  attrac- 
tive, and  the  dreamy  oblivion  which  follows  is 
very  pleasing. 

All  chloroform  cases  are  periodical  at  first,  and 
rarely  become  continuous,  and  yet  in  some  in- 
stances it  has  been  used  from  the  first  every  night. 
This  does  not  last  long,  as  mania  and  stages  of 
melancholy  soon  follow. 

In  one  case  a  man  would  provide  a  large  bottle 
of  chloroform,  arrange  all  his  business  in  ad- 
vance, and  at  a  certain  time  commence  using  it 
continuously  until  the  chloroform  was  gone.  Then 
he  would  recover  and  abstain  for  a  long  period; 
then  anticipate  and  provide  for  another  attack. 
He  seemed  to  have  power  to  abstain  for  a  certain 


COCAIN   AND    OTHER    DRUG    ADDICTIONS.  83 

length  of  time;,  then  gave  way  to  the  impulse 
abjectly.  Chloroform-takers  are  secretive  and 
rarely  acknowledge  the  addiction.  After  a  time 
they  suffer  from  gastric  troubles,  bad  circulation, 
emaciation,  trembling,  extreme  paleness,  and  great 
susceptibility  to  chills  with  depression.  ISTeuritis 
is  also  common,  and  chronic  cases  frequently  die 
from  tetanic  conditions.  Sudden  syncope  is  also 
common  and  fatal.  The  fascination  for  this  drug 
and  its  effects  is  an  insane  impulse  which  is  al- 
most insurmountable.  This  impulse  for  chloro- 
form comes  on  often  without  premonition.  A 
favorable  opportunity  to  procure  it  secretly  or 
the  odor  of  the  drug  seems  to  provoke  the  desire 
at  once.  After  the  impulse  dies  out,  the  efforts 
for  recovery  are  equally  earnest  and  energetic. 
No  one  can  be  more  earnest  and  seem  to  use  means 
to  prevent  relapse,  and  yet  the  slightest  oppor- 
tunity to  procure  chloroform  and  conceal  it  is  al- 
ways taken  advantage  of. 

In  the  treatment  this  element  of  insanity  must 
be  considered  as  well  as  the  extreme  liability  to 
relapse  at  the  most  unexpected  moment.  Death 
may  come  suddenly  at  any  time.  It  is  possible 
to  overcome  this  impulse  by  morphia  and  to 
change  the  case  to  a  morphinomania,  but  the  fas- 
cination of  chloroform  is  never  forgotten. 

In  the  treatment  the  complete  removal  of  the 
drug  is  necessary,  with  military  care  and  control 


84  DRUG   HABITS   AND    THEIR   TREATMENT. 

Physical  exercise  and  baths,  tonics,  alteratives  and 
concentrated  food  are  the  general  measures  useful. 
When  the  person  is  not  accustomed  to  other  nar- 
cotics many  premonitory  symptoms  of  the  insane 
impulse  appear.  Usually  irritative  melancholias, 
with  restlessness  and  depression  which  is  not 
affected  by  advice  or  surroundings.  Strychnin 
seems  to  increase  these  morbid  sensations  in  some 
instances;  in  others  it  is  very  useful,  particu- 
larly when  given  in  small  doses  and  often.  Chloral 
is  not  a  good  remedy.  The  stimulation  which  it 
produces  is  followed  by  greater  depression. 

Bromids  in  large  doses  may  break  up  the  im- 
pulse, but  leave  greater  depression  after  the  first 
effects  are  passed.  Opium  is  an  excellent  remedy, 
but  must  be  concealed  to  prevent  the  patient  from 
continuing  its  use.  After  hot  baths  and  massage, 
ten  drops  of  deodorized  tincture  of  opium  in  syrup 
of  wild  cherry  or  wintergreen  may  be  given  every 
two  hours  until  sleep  follows.  After  the  patient 
wakes,  an  active  mineral  cathartic  will  aid  in  re- 
lieving the  nervous  condition.  Hot  acid  drinks 
are  soothing,  and  may  be  given  very  often  in  some 
cases.  Eecovery  from  the  paroxysm  of  stupor  may 
be  accelerated  by  hot  salt  baths  and  sponging  and 
the  internal  use  of  some  mineral  acid.  Coffee 
infusion  can  be  given  with  great  advantage.  After 
the  paroxysm  has  passed  lupulin  and  quinin  can 
be  used  vsdth  excellent  results.     Arsenate  of  iron 


COCAIN   AND   OTHER  DRUG   ADDICTIONS.  85 

should  "be  given  as  a  general  tonic.  Iodide  of 
potassium  with  the  fluid  extract  of  conium  is  also 
very  valuable  as  a  continuous  remedy. 

The  chloroform-taker  should  be  under  the  con- 
stant care  of  the  physician  in  an  asylum;  if  at 
home,  faithful  attendance,  with  constant  watch- 
ing and  careful  regulation  of  all  the  surroundings 
and  modes  of  living. 

In  some  cases  the  irritative  depression  which 
seemingly  provokes  the  desire  for  cholorform  is 
traceable  to  chemical  changes  of  nutrition. 

The  good  results  following  from  active  catharsis 
and  elimination  by  the  bowels  seem  to  point  to 
ptomaine  compounds  in  the  body  acting  as  ex- 
citing causes.  The  value  of  an  eliminative  treat- 
ment brings  additional  confirmation  of  the  the- 
ory that  some  state  of  auto-intoxication  may  both 
precede  and  follow  the  cholorform  impulse. 
Chloroform-takers  can  never  restrict  themselves 
any  length  of  time  to  the  moderate  use  of  the 
drug.  The  inhalation  may  be  irregular  as  to 
time  and  free  interval,  but  the  desire  for  relief  is 
increased  with  each  repetition. 

Often  with  this  chronicity  appears  increased 
secretiveness  and  greater  efforts  to  conceal  it. 
In  a  few  cases  radical  changes  of  life  and  living 
with  active  constitutional  remedies  have  been  fol- 
lowed by  restoration.  The  use  of  alcohol  seems 
to  be  dangerous,  increasing  the  degeneration  and 


86  DRUG   HABITS    AND    THEIR    TREATMENT. 

rousing  up  mental  symptoms  not  noticed  before. 

Chloroform  should  rarely  be  used  in  cases  of 
hysteria  or  of  any  convulsive  neurosis,  particu- 
larly where  it  is  not  followed  by  any  unpleasant 
effects.  When  it  occurs  in  middle  or  later  life  the 
degenerations  are  very  serious,  and  the  cases  are 
early  fatal. 

In  early  life  the  problem  is  less  difficult.  In 
all  the  cases  there  are  serious  defects  of  both  the 
physical  and  moral  brain  which  require  prolonged 
treatment  and  the  skillful  use  of  means  applied 
with  military  exactness. 

OHLOEALISM 

Cliloralism  is  a  form  of  drug  addiction  which 
appears  to  be  more  common  among  women.  As  in 
all  other  forms  of  drug  addiction  some  previous 
neurosis  will  be  found  to  precede  the  first  use  of 
chloral.  The  sleep  which  it  produces  is  so  pro- 
found and  followed  by  no  unpleasant  sensations 
that  it  is  repeated  as  often  as  occasion  calls  for  it. 

Chloral  can  be  taken  secretly  for  a  long  time 
without  any  suspicion  of  its  use.  After  a  time  the 
effect  of  its  use  appears  in  disordered  digestion, 
the  irregular  heart's  action,  and  the  increase  of 
nervousness  and  muscular  unsteadiness.  In  per- 
sons past  middle  life  a  form  of  cardial  asthma 
with  a  tendency  to  delirium  appears.  These  and 
many  other  obscure  symptoms  finally  merge  into 


COCAIN    AND    OTHER   DRUG   ADDICTIONS.  87 

delirmm  and  death.  Kot  unfrequently  cases  of 
delirium  tremens  have  been  found  in  which  the 
drug  taken  was  chloral  and  not  spirits.  The  usnal 
trembling  and  delusions  of  persecution  and  hal- 
lucinations of  sight  and  loathsome  animals  are 
present.  Some  observers  have  noticed  that  chloral- 
takers  have  peculiar  blueness  of  the  extremities 
with  venous  congestion;  also  marked  listlessness 
and  lack  of  energy  as  prominent  symptoms  of 
this  addiction.  Choralism  is  confined  largely  io 
the  more  prosperous  classes  of  society.  This  drug 
can  be  disguised  in  many  ways  and  used  as  a 
fascinating  sleep  producer.  The  amount  varies 
from  twenty  to  two  hundred  grains  a  day.  Often 
considerable  time  will  elapse  before  toxic  symp- 
toms appear;  then,  suddenly  extreme  prostration 
with  delirium  comes  on,  ending  fatally.  Sudden 
palsies,  with  vaso-motor  disturbances,  heart  fail- 
ure, and  low  stages  of  delirium,  should  suggest 
chloralism,  particularly  if  alcohol,  opium,  cocain 
and  chloroform  can  be  excluded.  The  statement 
of  the  patient  concerning  his  condition  is  of  no 
value.  Where  the  history  indicated  extreme 
neuralgia  and  insomnia  and  a  sudden  passing 
away  of  these  conditions,  the  assumption  that 
chloral  is  used  is  possible.  When  it  is  established 
that  chloral  addiction  is  present,  the  patient 
should  be  isolated  at  once  and  placed  under  posi- 
tive restraint  and  the  drug  withdrawn.     Alcohol, 


OO  DRUG   HABITS   AND   THEIR  TREATMENT. 

opium,  chloroform,  ether  and  cocain  are  all  con- 
traindicated  as  substitutes.  Vegetable  narcotics, 
such  as  hyoscyamus,  valerian,  lupulin,  bull  nettle, 
and  others  of  this  class  may  be  given  as  substitutes 
and  withdrawn  at  the  earliest  moment.  Then 
comes  the  usual  tonic  treatment  of  nux  vomica, 
strychnin  and  arsenic.  The  latter  seems  to  be  the 
best  borne,  and  can  be  given  a  very  long  time. 
Cinchona  and  iron  are  also  excellent  drugs.  The 
insomnia  and  neuralgia  with  deranged  nutrition 
which  follow  the  withdrawal  should  be  treated 
with  baths,  foods,  and  careful  hygienic  manage- 
ment of  all  the  functional  activities  of  the  body. 
When  chloral  is  used  in  connection  with  other 
drugs,  profound  exhaustion  often  follows  its 
abandonment.  Sudden,  unexpected  death  occur- 
ring during  the  use  of  the  drug  is  common.  Many 
secret  remedies  for  neurotic  troubles  contain 
chloral,  and  decided  symptoms  of  chloralism  often 
appear.  Chloralism  has  been  mistaken  for  gen- 
eral paralysis,  neurasthenia,  and  hyperemia,  as 
well  as  several  affections  of  the  cord.  Many  opium 
and  alcohol  cases  are  found  io  be  complicated 
with  chloral  addiction,  and  their  recovery  is  more 
difficult. 

ETHEE 

The  use  of  ether  as  a  beverage  has  so  far  only 
been  noted  in  certain  distinct  sections  of  the 
country.     In  the  north  of  Ireland  it  has  attained 


COCAIN  AND   OTHER   DRUG  ADDICTIONS.  89 

such  prominence  as  to  become  the  subject  of  legis- 
lation and  medical  study.  In  certain  sections  of 
Wisconsin  and  Pennsylvania  the  sale  of  cheap 
snlphuric  ether  has  assumed  some  prominence. 
Many  persons  use  it  regularly.  The  effect  of  the 
ether  is  rapid  exhilaration,  with  tnmnltuous  satis- 
faction and  joy;  then  a  variable  period  of  stupor 
and  sleep,  and  recovery.  When  this  is  used  often 
digestion  suffers  and  conditions  of  hyperesthesia 
and  anesthesia  follow.  Sometimes  the  excited 
stage  is  a  form  of  acute  mania  with  violent  symp- 
toms. On  recovery  depression  and  melancholia 
follow.  Fortunately  no  general  addiction  has  been 
so  far  noted.  The  few  cases  which  have  appeared 
have  had  alcohol  or  opium  addiction  before,  and 
the  use  of  ether  was  a  more  pleasant  addiction 
than  the  other.  The  mind  in  all  such  cases  is 
more  or  less  impaired  and  recovery  will  depend 
upon  the  use  of  the  various  means  found  useful  in 
other  cases  of  addiction. 

TEA   HABIT 

Tea  inebriety  is  one  of  the  milder  addictions 
that  only  occasionally  comes  under  medical  no- 
tice. It  is  a  well-recognized  fact  clinically  that  a 
number  of  persons  seriously  injure  themselves  by 
the  excessive  use  of  tea,  the  symptoms  of  which 
are  usually  gastric  derangement,  neuralgias, 
muscular  twitchings    and   trembling,   great  irri- 


90  DRUG   HABITS    AND    THEIR   TREATMENT. 

lability,  with  hyperexcitability.  In  some  instances 
delusions  of  fear  and  hallucinations  of  voices  at 
night,  bad  dreams,  painful  insomnia,  are  com- 
mon. Many  single  women,  past  middle  life  are 
clearly  tea  inebriates.  Often  some  form  of  deliri- 
um breaks  out  or  some  obscure  neuralgic  pain 
which  is  attributed  to  many  very  serious  diseases 
appears.  Many  of  these  eases  are  unconscious  of 
the  effects  of  excessive  tea-drinking,  and  attribute 
the  symptoms  to  other  causes.  The  general  symp- 
toms may  be  described  by  the  terms  neurasthenia, 
cerebrasthenia,  and  anemia.  The  removal  of  the 
tea  and  active  hygienic  treatment  is  usually  suffi- 
cient. Mineral  tonics  and  bitter  barks  and  acid 
drinks  are  the  usual  remedies.  Some  of  these 
cases  end  fatally  from  acute  exhaustion  and  heart 
failure ;  others  seem  to  suffer  from  profound  star- 
vation, food  not  being  assimilated  and  poisons 
gathering  in  the.  system  become  sources  of  acute 
inflammation.  Many  obscure  neurotic  cases  will 
be  found  to  follow  the  action  of  the  active  prin- 
ciple of  tea,  affecting  the  cerebral  centers. 

COFFEE   ADDICTIOJf 

Coffee  addiction  belongs  to  the  same  class  of 
irritant  narcotics,  and  when  taken  in  excess  pro- 
duces semi-delirium  and  great  prostration.  Coffee- 
drinkers  sometimes  under  great  excitement  de- 
velop delusional  states,  usually  of  the  grandiose 


COCAIN    AND    OTHER   DRUG   ADDICTIONS.  91 

character,  and  rarely  violent  or  destructive.  Sus- 
picions of  wrong  and  injustice  may  occur.  These 
alternate  with  extravagant  credulit}'.  In  the  treat- 
ment arsenic  and  strychnia  are  valuable  tonics. 
Elimination  by  baths  and  catharsis  and  nerve  and 
brain  rest  are  especially  valuable.  Both  tea  and 
coffee  can  become  dangerous  addictions  where  used 
by  neurotics,  and  often  require  medical  aid  and 
counsel  to  be  relieved.  Frequently  they  precede 
the  use  of  opium  and  alcohol,  and  are  very  sig- 
nificant addictions. 

AESE^^C 

The  use  of  arsenic  as  a  stimulant  has  been  noted 
in  many  sections  of  the  country.  In  the  reported 
cases  its  effects  were  those  of  a  pleasing  tonic. 
The  skin  soon  becomes  pearly  and  white,  the  e3"es 
take  on  a  brilliant  hue,  and  the  face  becomes 
plump  and  a  general  air  of  indifference  is  mani- 
fested. There  is  a  certain  tolerance  to  this  drug 
in  such  cases,  and  apparent  exhilaration  which  fol- 
low from  its  use.  In  the  cases  which  have  been 
observed  fifteen  to  twenty-five  grain  a  day  were 
used,  and  after  a  year  or  so  death  followed  sud- 
denly from  apparent  heart  failure.  In  others 
slight  degrees  of  dementia  preceded  the  fatal  issue. 
In  all  cases  the  perspiration  gave  out  a  strong 
metallic  odor.     Fortunately  these  cases  are  un- 


92  DRUG    HABITS    AND    THEIR   TREATMENT. 

common,  and  seem  so  far  to  be  confined  to  women 
and  neurotics  of  the  better  classes. 

EAU  DE    COLOGNE 

Another  form  of  addiction  has  been  noticed  and 
described  at  some  length,  that  of  the  use  of  Co- 
logne water.  In  these  cases  the  narcotic  action  is 
simply  that  of  alcohol,  often  of  an  inferior  kind, 
concealed  by  the  odor  of  the  perfume.  It  is  prob- 
able that  the  odor  is  quite  as  much  of  a  fascination 
as  the  spirit  itself.  The  conditions  which  follow 
are  substantially  those  of  delirium  and  melan- 
cholia, with  obscure  and  complex  nerve  disorders, 
which  readily  disappear  on  the  removal  of  the 
cause.  These  cases  are  all  alcoholics,  and  are 
likely  to  develop  delirium  and  serious  nutrient 
degenerations.  The  external  use  of  these  odorif- 
erous spirits  by  drug  neurotics  is  always  unsafe, 
and  open  to  suspicion.  When  taken  internally  its 
treatment  and  care  are  along  such  lines  as  those 
of  alcohol. 

GINGER 

Jamaica  ginger  is  another  one  of  those  alcoholic 
preparations  which  have  become  popular  in  cer- 
tain sections.  They  are  all  forms  of  cheap  alco- 
hol concealed  with  solutions  of  ginger,  the  latter 
being  only  a  mild  stimulant  and  irritant,  the 
former  having  the  same  effect  as  other  spirits. 
Several  cases  have  occurred   where  its   use  was 


COCAIN   AND    OTHER   DRUG   ADDICTIONS.  93 

decided  to  be  harmless  and  in  no  way  responsible 
for  the  mental  disturbance  and  irregular  conduct 
following.  This  is  incorrect.  The  use  of  Jamaica 
ginger  usually  containing  from  ten  to  forty  per 
cent,  of  alcohol  is  precisely  like  that  of  other 
alcohols,  and  should  be  treated  in  the  same  way, 
and  is  certainly  followed  by  the  same  symptoms, 
only  less  prominently. 

PAEALDEHYD 

Paraldehyd  has  been  used  by  neurotics  to  some 
extent,  and  may  properly  be  called  one  of  the 
addictions.  Excessive  prostration  and  delirium 
are  the  common  symptoms  which  follow.  The 
removal  of  the  drug  and  the  causes  which  impel 
its  use  are  the  obvious  means  required  for  the 

treatment. 

gelse:miu:m 

Gelsemium  is  another  drug  which  has  been  used 
as  a  tonic  and  narcotic.  The  common  symptoms 
are  stupor,  emaciation,  listlessness,  delusions  and 
hallucinations,  followed  by  an  early  death.  This 
drag  is  used  first  for  the  relief  of  pain,  and  its 
effects  are  so  pleasing  that  its  use  is  continued. 

These  are  only  the  more  common  of  the  drugs 
whose  poisonous  use  has  attracted  medical  attention. 
They  may  be  called  drug  addictions  for  the  reason 
that  they  often  begin  with  and  without  the  pre- 
scription of  a  physician,  and  are  taken  secretly. 


94  DRUG   HABITS   AND    THEIR   TREATMENT. 

When  the  derangement  which  follows  from  their 
use  becomes  prominent  the  medical  man  is  called. 
Unfortunately  many  of  these  cases  have  reached 
chronic  stages  before  this  period,  and  the  result 
is  that  the  treatment  is  diflBcult  and  uncertain. 
Many  of  them  require  asylum  treatment;  others 
may  be  treated  at  home,  but  all  need  exact  means 
and  measures  for  restoration  and  relief.  The  de- 
lusion that  these  unfortunates  have  full  posses- 
sion of  their  will  to  abstain  or  continue  is  fast 
passing  away.  We  are  now  able  to  recognize  in 
most  of  these  cases  well-defined  diseases  that  begin 
and  follow  a  progressive  line  on  to  death  or  resto- 
ration. While  the  treatment  is  much  more  posi- 
tive through  the  cooperation  of  the  patient,  it  is 
only  by  the  use  of  physical  means  and  measures 
that  any  permanent  results  can  be  expected. 


INDEX. 


Alcohol,   the   study   of,    9 

Cofifee    addiction,    mental 

its  influence  as  contrib- 

conditions, 90 

utory,  to  disease,  9 

treatment  of,  91 

in  neuroses,  10 

in     relation     to     other 

in  medical  and  surgical 

drug  habits,  91 

diseases,  10 

Cologne   water,   habit,   92 

as  a  medicine,  10 

physical  results,  92 

as  a  toxin  producer,  10 

Cocain      addiction,      with 

inebriety  a  disease,  10 

opium,  75 

drinkers,   19  . 

mental  confusion,  yS 

the  removal  of,  48 

phy  sical   changes 

Alcoholism,  the  progress 

caused,  77 

of,  II 

prognosis,  78 

symptoms  of,  12 
Alcoholic     parents,     chil- 
,  dren  of,  21 

treatment,  78 
diet    and    moral    treat- 
ment, 79-81 
Drunkenness,       curability 

Arsenic,   91 

of,    II 

Baths,    50 

Drink  habit,  forms  of,  13 

Convulsions,  38 

Drinkers,  periodical,   14 

following  use  of  opium, 

continuous,  13 

38 

contagious,   13 

Chloroform,  abuse  of,  82 

concealed  addiction  of. 

mental    state    in    abuse 

of,  82 
example  of  abuse,  83 

IS 

impulsive,   16 
impulsive   character   of, 

17 
impulsive  causes  of,  18 

Cabanis;    of  France,  11 

Chloralism,    physical   and 

eccentric  class,  18 

mental  states,  87 

heredity  of,  18 

treatment,  88 

heredity   of,   direct   and 

prognosis,  88 

indirect,  18-40 

II. 


INDEX. 


heredity    of,    producing 

criminals,  21 
heredity     of,    examples 
and  forms   of  predis- 
positions, 18 
Drugs,     disease    impulse, 
23 
disease,  liability  to  men- 
tal change  and  physi- 
cal disease,  24 
Delirium  tremens,  how  in- 
duced, 33 
how  manifested,  33 
prognosis,  34 
treatment,  34 
other    diseases     caused 
by,  36-37 
Dipsomania,  differs   from 
inebriety,   30 
how  manifested,  31 
prognosis,  34 
treatment,  34 
Ether    addiction,    mental 

state  in,  89 
Galen,  11 
Ginger  tincture   (Jamaica 

ginger),  92 
Gelsemium,  its  abuse,  93- 

94 
Habit,  the  popular  defini- 
tion, 9 
Hippocrates,  11 
Inebriety,  the  study  of  in 
America,  11 


the     quarterly    Journal 

of,  II 
epileptoid  types,    15 
produces  permanent 

mental  disorders,  16 
examples  and  forms  of 

predisposition,    18-22 
conditions  conducive  to, 

25-47 
contagious,       examples 

of,  25 
types  of,  26 

change  of  character,  35 
contributing  causes,  41, 

42,  43,  44 
pathology,  45 
symptoms,  46-47 
treatment,  48  to  58 
prognosis,  58,  59,  60 
Inebriate  asylum,  the  first 

in  America,  11 
Magnan,  38-41 
Mattison,  68 
Morel,  of  France,  20 
Opium  inebriety,  users  in 
this  country,  61 
diathesis  favored  by  the 
following    conditions, 
63-64 
treatment  of,  64  to  73 
Parish,  67 
Paraldehyde,  93 
Rush,    II 
Salvator,  of  Russia,  11 


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